Younger gestational age is associated with increased risk of adverse neurodevelopmental outcome during infancy in congenital diaphragmatic hernia
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Published on: November 20, 2015
Enrico Danzer1, Marsha Gerdes1, Jo Ann D'Agostino1
1The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Insights
Infants with congenital diaphragmatic hernia (CDH) born before 39 weeks gestation face higher risks of neurodevelopmental delays, particularly in motor skills. Earlier delivery significantly impacts outcomes for these children.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Developmental Neuroscience
Background:
- Congenital diaphragmatic hernia (CDH) survivors face potential short-term neurodevelopmental (ND) challenges.
- Gestational age (GA) at delivery is a critical factor influencing infant health and development.
Purpose of the Study:
- To investigate the impact of gestational age (GA) on short-term neurodevelopmental (ND) outcomes in congenital diaphragmatic hernia (CDH) survivors.
- To identify specific ND domains affected by earlier delivery in CDH patients.
Main Methods:
- 135 CDH patients underwent neurodevelopmental assessment using the Bayley Scales of Infant Development-III.
- Gestational age was categorized as preterm (24-33 weeks), late preterm (34-36 weeks), near term (37-38 weeks), and full term (39-41 weeks).
- Neurodevelopmental delay was defined as a composite score ≤85; severe impairment as a score ≤69.
Main Results:
- CDH infants born before 39 weeks gestation showed significantly higher rates of neurodevelopmental delays compared to full-term infants (P=0.005).
- Motor composite and fine motor scores were significantly lower in near-term and late preterm CDH infants versus full-term peers (P=0.009 and P<0.01).
- Preterm CDH infants exhibited the lowest scores across all neurodevelopmental domains (P<0.05).
Conclusions:
- Gestational age significantly impacts short-term neurodevelopmental outcomes in CDH survivors.
- Late preterm and near-term CDH infants, in addition to preterm infants, are at increased risk for neurodevelopmental delays.
- Motor function is the most vulnerable neurodevelopmental domain affected by earlier delivery in CDH patients.
Background:
The purpose of the study was to investigate the impact of gestational age (GA) on short-term neurodevelopmental (ND) outcomes in congenital diaphragmatic hernia survivors.
Materials:
Between 6/2004 and 2/2013, 135 consecutive CDH patients underwent ND assessment using the Bayley Scales of Infant Development-III at a median follow-up age of 13months (range, 5-36). ND delay was defined by a score of ≤85 in any of the composite scales. Severe impairment was defined as a score of ≤69 in at least one domain. The effect of GA was evaluated as continuous and categorical variables. GA at delivery was grouped into full term (39-41weeks), near term (37-38), late preterm (34-36), and preterm (24-33).
Results:
Median GA at delivery was 38weeks (range, 24-41). Fifty (37%) patients were delivered full term, 59 (44%) near term, 16 (12%) late preterm, and 10 (7%) preterm. CDH children born before 39weeks' gestation were more likely to score below average (P=0.005) with corrected age for at least one composite score compared to full term peers. Cognitive (P=0.06) and language (P=0.08) scores tended to be lower in the near-term and late-preterm group compared to full-term CDH infants. Patients born near term and late preterm had significantly lower motor composite and fine motor scores compared to full-term children (P=0.009 and P<0.01, respectively). Preterm children scored the lowest in all composite scales (P<0.05).
Conclusions:
Compared to term infants, not only preterm but also late preterm and near-term CDH children carry an increased risk of ND delays. Motor performance appears most susceptible to earlier delivery.
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