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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental Outcomes following Preterm Birth and the Association with Postmenstrual Age at Discharge
Polly Kellner1, Jenny Kwon1,2, Joan Smith3
1Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California.
Insights
Longer neonatal intensive care unit (NICU) stays for preterm infants born before 32 weeks estimated gestational age (EGA) are linked to poorer neurodevelopmental outcomes. Optimizing the NICU environment is crucial for improving cognitive, language, and motor development in these vulnerable infants.
Area of Science:
- Neonatalogy
- Neurodevelopmental Pediatrics
- Developmental Psychology
Background:
- Preterm infants born before 32 weeks estimated gestational age (EGA) face significant risks for developmental delays.
- The neonatal intensive care unit (NICU) environment may influence neurodevelopmental trajectories in these infants.
Purpose of the Study:
- To determine the prevalence of motor, cognitive, and language delays in preterm infants (<32 weeks EGA).
- To investigate the association between NICU discharge timing and neurodevelopmental outcomes in early childhood.
Main Methods:
- Retrospective study of 172 preterm infants (<32 weeks EGA) admitted to a level-IV NICU.
- Collected medical data, including NICU discharge timing.
- Assessed neurodevelopment using Bayley Scales of Infant and Toddler Development (Bayley-III) at 1-2 years corrected age.
Main Results:
- Higher postmenstrual age (PMA) at NICU discharge was associated with poorer cognitive, language, and motor scores.
- Each additional week of hospitalization correlated with an average decrease of 1.1 cognitive, 1.0 motor, and 0.5 language points on the Bayley-III.
- Medical factors like lower EGA, necrotizing enterocolitis, and prolonged oxygen need were linked to later discharge.
Conclusions:
- Extended NICU hospitalization is associated with impaired neurodevelopment in preterm infants, independent of medical risk factors.
- These findings underscore the importance of the NICU environment in shaping developmental outcomes.
- Strategies to optimize the NICU environment are needed to mitigate neurodevelopmental challenges.
Objective:
This study aimed to (1) define the prevalence of motor, cognitive, and language delays in preterm infants born <32 weeks estimated gestational age (EGA); and (2) identify the relationship between the timing of discharge from the neonatal intensive care unit (NICU) and neurodevelopmental outcome in early childhood.
Study Design:
This retrospective study of 172 preterm infants born <32 weeks EGA and hospitalized in a level-IV NICU captured medical factors, including timing of discharge, from the NICU stay. Standardized developmental testing at 1 to 2 years corrected age was conducted in the newborn follow-up clinic.
Results:
At 1 to 2 years corrected age, the sample had an average Bayley Scales of Infant and Toddler Development (Bayley-III) cognitive composite score of 91.5 ± 17.4, language composite score of 84.5 ± 17.3, and motor composite score of 88.9 ± 18.4. Lower EGA at birth, necrotizing enterocolitis, patent ductus arteriosus, and oxygen requirement for >28 days were independently associated with higher postmenstrual age (PMA) at NICU discharge. Higher PMA at discharge was associated with poorer cognitive outcome [p < 0.001, β = -1.1 (-1.6, -0.7)], poorer language outcome [p = 0.049, β = -0.5 (-0.9, -0.003)], and poorer motor outcome [p <0.001, β = -1.0 (-1.5, -0.5)]. For every additional week of hospitalization, scores were an average of 1.1 points lower in cognitive, 1.0 point lower in motor, and 0.5 points lower in language domains of the Bayley-III assessment.
Conclusion:
Poorer cognitive, language, and motor outcomes were associated with longer hospitalization, even after controlling for medical risk factors known to be associated with poorer outcome. This provides further evidence for the potential role of the environment in impacting developmental outcomes of infants hospitalized in the NICU.
Key Points:
· There are high rates of developmental impairment among preterm infants born <32 weeks at 1 year to 2 years.. · The longer the infant is exposed to the NICU environment, the higher the risk of neurodevelopmental challenges.. · These findings provide increased motivation for optimizing the early NICU environment..
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