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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental Outcomes at Two Years of Age for Premature Infants Diagnosed With Neonatal Obstructive Sleep Apnea
Anuja Bandyopadhyay1, Heidi Harmon2, James E Slaven3
1Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Insights
Neonatal obstructive sleep apnea (OSA) in preterm infants did not significantly impact neurodevelopmental scores. However, elevated end-tidal CO2 levels, independent of apnea severity, may predict poorer cognitive outcomes in these infants.
Area of Science:
- Neonatology
- Pediatric Neurology
- Sleep Medicine
Background:
- Neurocognitive deficits are documented in school-aged children with sleep apnea.
- The impact of obstructive sleep apnea (OSA) on neurodevelopment in preterm infants remains unclear.
Purpose of the Study:
- To investigate the association between neonatal obstructive sleep apnea (OSA) and neurodevelopmental outcomes in preterm infants.
- To identify potential predictors of neurodevelopmental deficits in this vulnerable population.
Main Methods:
- Retrospective chart review of preterm infants (<37 weeks) undergoing polysomnography (PSG) and neurodevelopmental assessment (Bayley Scales of Infant and Toddler Development, 3rd Edition).
- Exclusion of infants with severe comorbidities (e.g., grade IV intraventricular hemorrhage, cyanotic heart disease).
- Sleep apnea defined as an apnea-hypopnea index (AHI) > 1 event/h; regression analyses performed to correlate PSG parameters with neurodevelopmental scores.
Main Results:
- Fifteen preterm infants were included, with a median postmenstrual age of 41 weeks at PSG.
- The median apnea-hypopnea index (AHI) was 17.4 events/h; median cognitive, language, and motor scores were within one standard deviation of published norms.
- Mean end-tidal CO2 negatively correlated with cognitive scores (P = .01), but AHI did not significantly associate with any neurodevelopmental outcome.
Conclusions:
- Preterm infants with neonatal OSA demonstrated neurodevelopmental scores comparable to norms.
- Mean end-tidal CO2, irrespective of AHI, may serve as a potential biomarker for predicting cognitive outcomes in preterm infants with OSA.
- Further research is warranted to elucidate the specific mechanisms linking CO2 levels and neurodevelopmental trajectories.
Study Objectives:
Neurocognitive deficits have been shown in school-aged children with sleep apnea. The effect of obstructive sleep apnea (OSA) on the neurodevelopmental outcome of preterm infants is unknown.
Methods:
A retrospective chart review was performed for all preterm infants (< 37 weeks) who had neonatal polysomnography (PSG) and completed neurodevelopmental assessment with the Bayley Scales of Infant and Toddler Development, 3rd Edition, between 2006 to 2015 at Riley Hospital. Exclusion criteria included grade IV intraventricular hemorrhage, tracheostomy, cyanotic heart disease, severe retinopathy of prematurity, craniofacial anomalies, or central and mixed apnea on PSG. Sleep apnea was defined as an apnea-hypopnea index (AHI) > 1 event/h. Regression analyses were performed to find a relationship between PSG parameters and cognitive, language, and motor scores.
Results:
Fifteen patients (males: n = 10) were eligible for the study. Median postmenstrual age at the time of the PSG was 41 weeks (37-46). Median AHI for the cohort was 17.4 events/h (2.2-41.3). Median cognitive, language, and motor scores were 90 (65-125), 89 (65-121), and 91 (61-112), respectively. Mean end-tidal CO2 (median 47 mm Hg [25-60]) negatively correlated with cognitive scores (P = .01) but did not significantly correlate with language or motor scores. AHI was not associated with cognitive, language, or motor scores.
Conclusions:
The median score for cognitive, language, and motor scores for preterm infants with neonatal OSA were within one standard deviation of the published norm. Mean end-tidal CO2, independent of AHI, may serve as a biomarker for predicting poor cognitive outcome in preterm infants with neonatal OSA.
Commentary:
A commentary on this article appears in this issue on page 1233.
