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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neonatal Factors Associated with a Good Neurodevelopmental Outcome in Very Preterm Infants
Elizabeth V Asztalos1, Paige T Church1, Patricia Riley2
1Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Insights
The absence of major neonatal comorbidities like bronchopulmonary dysplasia is linked to better neurodevelopmental outcomes in extremely preterm infants. Shorter durations of respiratory support and parenteral nutrition also correlate with improved cognitive, language, and motor development.
Area of Science:
- Neonatology
- Developmental Pediatrics
- Perinatal Medicine
Background:
- Extremely preterm infants (<29 weeks' gestation) face significant risks for adverse neurodevelopmental (ND) outcomes.
- Identifying early indicators of good neurodevelopmental outcomes is crucial for optimizing care.
Purpose of the Study:
- To investigate the association between the absence of neonatal comorbidities and clinical progress indicators with good neurodevelopmental outcomes at 18 months corrected age.
- To analyze a national cohort of infants born before 29 weeks' gestation.
Main Methods:
- Retrospective analysis of a national cohort of preterm infants (<29 weeks' gestation) born in 2010-2011.
- Neurodevelopmental outcomes assessed at 18 months corrected age using the Bayley Scales of Infant and Toddler Development, 3rd ed. (Bayley-III).
- Univariate analyses and regression estimates were used to determine odds of good ND outcomes (composite scores ≥100 in cognitive, language, and motor domains).
Main Results:
- In a cohort of 2,069 infants, the absence of bronchopulmonary dysplasia, necrotizing enterocolitis, and severe neurological injury was associated with good cognitive, language, and motor outcomes.
- Reduced duration of positive pressure support and total parenteral nutrition was linked to better motor outcomes and showed a positive trend for cognitive and language scores.
Conclusions:
- Absence of major neonatal comorbidities is a significant predictor of good neurodevelopmental outcomes in extremely preterm infants.
- Minimizing the duration of mechanical ventilation and parenteral nutrition may positively influence neurodevelopmental trajectories.
Abstract:
Objective This study aims to examine the association between the absence of neonatal comorbidities, as well as the presence of indicators of clinical progress with good neurodevelopmental (ND) outcomes, at 18 months corrected age in a national cohort of preterm infants of < 29 weeks' gestation. Design Study subjects included preterm infants (< 29 weeks' gestation) born in 2010 and 2011. Univariate analyses were conducted and regression estimates were calculated for variables where odds of a good ND outcome, composite scores ≥ 100 in three domains (cognitive, language, and motor) in the Bayley Scales of Infant and Toddler Development, 3rd ed. (Bayley-III), were estimated. Results In total, 2,069 infants were included in the analyses. For all three domains evaluated on the Bayley-III, cognition, language, motor, respectively, the absence of three major morbidities was associated with a score ≥ 100: bronchopulmonary dysplasia, necrotizing enterocolitis, and severe neurological injury. Less time spent on positive pressure support and on total parenteral nutrition administration were associated with a positive motor outcome and showed a positive trend for both cognition and language scores. Conclusion The absence of neonatal comorbidities was associated with good ND outcome. Less time spent on positive pressure support and parenteral nutrition may also contribute to a good ND outcome.
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