Long-Term Neurodevelopmental Outcomes of Premature Infants in Singapore

Area of Science:

• Neonatal Medicine
• Developmental Pediatrics
• Public Health

Background:

• Neonatal care advancements improve survival but raise concerns about neurodevelopmental impairment.
• This study examines long-term neurodevelopmental outcomes in very low birthweight infants born in the 2000s versus the 1990s.
• The predictive value of early (2-year) neurodevelopmental assessment for later outcomes (5 and 8 years) was investigated.

Purpose of the Study:

• To compare neurodevelopmental outcomes at ages 5 and 8 years for very low birthweight infants born in two distinct decades.
• To determine if early neurodevelopmental assessments at 2 years predict later outcomes.
• To identify trends in neurodevelopmental impairment, intelligence quotient (IQ), and specific impairments like visual and hearing loss.

Main Methods:

• Retrospective cohort study of very low birthweight infants (<1250g) admitted between 1994-1995 (Epoch I) and 2004-2005 (Epoch II).
• Neurodevelopmental impairment defined by IQ < 70, cerebral palsy, legal blindness, or hearing impairment requiring aids.
• Neurodevelopmental assessments conducted at 2, 5, and 8 years of age.

Main Results:

• Mean gestational age was lower in Epoch II (28.1 weeks) compared to Epoch I (29.4 weeks).
• Overall rates of death or neurodevelopmental impairment did not significantly differ between epochs at 5 or 8 years.
• Epoch II showed improved visual impairment rates (10.7% vs 34.0% at 8 years) and higher mean IQ scores at 5 and 8 years compared to Epoch I.

Conclusions:

• Neurodevelopmental outcomes for very low birthweight infants have not worsened over a decade, despite decreasing gestational age.
• Long-term improvements include higher IQ scores and reduced visual impairment.
• Infants without neurodevelopmental impairment at 2 years appear to maintain positive outcomes, suggesting developmental monitoring may suffice over routine formal IQ assessments.