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Neurodevelopmental Outcomes Among Extremely Preterm Infants 6.5 Years After Active Perinatal Care in Sweden
Fredrik Serenius1, Uwe Ewald2, Aijaz Farooqi3
1Section for Pediatrics, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden2Department of Pediatrics, Institute of Clinical Sciences, Umeå University, Umeå, Sweden.
Insights
Children born extremely preterm (<27 weeks) showed significantly higher rates of moderate to severe neurodevelopmental disabilities at 6.5 years. Active perinatal care improved survival but increased the need for specialized support for these children.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Public Health
Background:
- Active perinatal care improves survival for extremely preterm infants (<27 weeks' gestational age).
- Concerns exist regarding potential increases in disabled survivors with improved survival rates.
Purpose of the Study:
- To assess the neurodevelopmental outcomes at 6.5 years of age in a national cohort of Swedish children born extremely preterm.
- To compare these outcomes with those of a matched cohort of children born at term.
Main Methods:
- Population-based prospective cohort study in Sweden (2004-2007 births).
- Follow-up of 486 extremely preterm survivors to 6.5 years, compared with 371 term-born controls.
- Neurodevelopmental assessment using Wechsler Intelligence Scale for Children (WISC-IV), clinical examinations, and parental questionnaires.
Main Results:
- Extremely preterm children had significantly lower WISC-IV scores (14.2 points lower) than controls.
- Higher rates of moderate/severe cognitive disability (30% vs 2.5%), cerebral palsy (9.5% vs 0%), blindness (2.0% vs 0%), and hearing impairment (2.1% vs 0.5%) in the preterm group.
- 36.1% of extremely preterm children had no disability, while 13.4% had severe disability at 6.5 years.
Conclusions:
- A significant proportion of extremely preterm children experience moderate to severe neurodevelopmental disabilities at 6.5 years.
- Disability rates increased from 2.5 to 6.5 years in the extremely preterm cohort.
- Findings are crucial for healthcare professionals, planners, and families counseling regarding extremely preterm births.
Importance:
Active perinatal care increases the rate of survival of extremely preterm infants, but there are concerns that improved survival might increase the rate of disabled survivors.
Objective:
To determine the neurodevelopmental outcomes of a national cohort of children 6.5 years of age who had been born extremely preterm (<27 weeks' gestational age) in Sweden.
Design, Setting, And Participants:
Population-based prospective cohort study of consecutively born extremely preterm infants. All of these infants were born in Sweden during the period from April 1, 2004, to March 31, 2007. Of 707 live-born extremely preterm infants, 486 (68.7%) survived to 6.5 years of age. These children were assessed and compared with matched controls who had been born at term. Comparison estimates were adjusted for demographic differences. Assessments ended in February 2014, and analysis started thereafter.
Main Outcomes And Measures:
Cognitive ability was measured with the fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV), and the mean (SD) scores of the children who had been born extremely preterm were compared with those of the controls. Clinical examinations and parental questionnaires were used for diagnosis of cerebral palsy, hearing and vision impairments, and cognition for the children who were not assessed with the WISC-IV.
Results:
Of 486 eligible infants who were born extremely preterm, 441 (90.7%) were assessed at 6.5 years of age (59 by medical record review only) alongside 371 controls. The adjusted mean (SD) full-scale WISC-IV score was 14.2 (95% CI, 12.1-16.3) points lower for children who had been born extremely preterm than for controls. Cognitive disability was moderate for 18.8% of extremely preterm children and 2.2% of controls (P < .001), and it was severe for 11.1% of extremely preterm children and 0.3% of controls (P < .001). Cerebral palsy was observed in 9.5% of extremely preterm children and 0.0% of controls (P < .001), blindness was observed in 2.0% of extremely preterm children and 0.0% of controls (P < .001), and hearing impairment was observed in 2.1% of extremely preterm children and 0.5% of controls (P = .07). Overall, 36.1% (95% CI, 31.7%-40.6%) of extremely preterm children had no disability, 30.4% (95% CI 26.3%-34.8%) had mild disability, 20.2% (95% CI, 16.6%-24.2%) had moderate disability, and 13.4% (95% CI, 10.5%-16.9%) had severe disability. For extremely preterm children, moderate or severe overall disability decreased with gestational age at birth (adjusted odds ratio per week, 0.65 [95% CI, 0.54-0.79]; P < .001) and increased from 26.6% to 33.5% (P = .01) for children assessed both at 2.5 and 6.5 years.
Conclusions And Relevance:
Of the 441 extremely preterm infants who had received active perinatal care, 293 (66.4%) had no or mild disability at 6.5 years; of the 371 controls, 11 (3.0%) had moderate or severe disability. Disability rates at 6.5 years increased relative to the rates at 2.5 years. Results are relevant for health care professionals and planners, and for clinicians counseling families facing extremely preterm births.
