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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental outcome of Italian preterm ELBW infants: an eleven years single center cohort
Camilla Caporali1,2, Stefania Longo3, Giovanna Tritto1,4
1Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.
Insights
Extremely low birth weight infants (ELBWi) show improved survival without neurodevelopmental impairment. Language deficits were common, with abnormal ultrasound findings and bronchopulmonary dysplasia as key risk factors.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Neuroscience
Background:
- Extremely low birth weight infants (ELBWi) face heightened risks for neuropsychiatric conditions.
- Early identification of predictors is crucial for timely intervention in ELBWi.
- Limited research exists on neurodevelopmental outcomes for Italian ELBWi.
Purpose of the Study:
- To assess neurodevelopmental outcomes at 24 months corrected age in a decade-long cohort of Italian ELBWi.
- To identify early risk factors associated with adverse neurodevelopmental outcomes in this population.
Main Methods:
- A cohort of 176 ELBWi (birth weight <1000g) was studied over 11 years.
- Neurodevelopment was evaluated at 24 months corrected age using the Griffiths' Mental Developmental Scales Extended Revised (GMDS-ER).
- Statistical models analyzed correlations between neonatal variables and neurodevelopmental outcomes (normal, minor, or major sequelae).
Main Results:
- 67% of ELBWi had normal neurodevelopmental outcomes at 24 months.
- Cognitive impairment was the most frequent major sequela (8.52%).
- Severely abnormal ultrasound findings and bronchopulmonary dysplasia independently predicted major and minor neurodevelopmental sequelae.
Conclusions:
- Italian ELBWi cohort demonstrates improved survival without neurodevelopmental impairment compared to international data.
- A distinct developmental profile emerged, with language domain deficits being most prominent.
- Confirmed abnormal ultrasound findings and bronchopulmonary dysplasia as significant risk factors for adverse outcomes.
Background:
Preterm extremely low birth weight infants (ELBWi) are known to be at greater risk of developing neuropsychiatric diseases. Identifying early predictors of outcome is essential to refer patients for early intervention. Few studies have investigated neurodevelopmental outcomes in Italian ELBWi. This study aims to describe neurodevelopmental outcome at 24 months of corrected age in an eleven-year single-center cohort of Italian ELBWi and to identify early risk factors for adverse neurodevelopmental outcomes.
Methods:
All infants born with birth weight < 1000 g and admitted to the Neonatal Intensive Care Unit of the "Fondazione IRCCS Policlinico San Matteo" hospital in Pavia, Italy, from Jan 1, 2005 to Dec 31, 2015 were eligible for inclusion. At 24 months, Griffiths' Mental Developmental Scales Extended Revised (GMDS-ER) were administered. Neurodevelopmental outcome was classified as: normal, minor sequelae (minor neurological signs, General Quotient between 76 and 87), major sequelae (cerebral palsy; General Quotient ≤ 75; severe sensory impairment). Univariate and multivariate multinomial logistic regression models were performed to analyze the correlation between neonatal variables and neurodevelopmental outcome.
Results:
176 ELBWi were enrolled (mean gestational age 26.52 weeks sd2.23; mean birthweight 777.45 g sd142.89). 67% showed a normal outcome at 24 months, 17% minor sequelae and 16% major sequelae (4.6% cerebral palsy on overall sample). The most frequent major sequela was cognitive impairment (8.52%). In the entire sample the median score on the Hearing-Speech subscale was lower than the median scores recorded on the other subscales and showed a significantly weaker correlation to each of the other subscales of the GMDS-ER. Severely abnormal cUS findings (RRR 10.22 p 0.043) and bronchopulmonary dysplasia (RRR 4.36 p 0.008) were independent risk factors for major sequelae and bronchopulmonary dysplasia for minor sequelae (RRR 3.00 p 0.018) on multivariate multinomial logistic regression.
Conclusions:
This study showed an improvement in ELBWI survival rate without neurodevelopmental impairment at 24 months compared to previously reported international cohorts. Cognitive impairment was the most frequent major sequela. Median scores on GMDS-ER showed a peculiar developmental profile characterized by a selective deficit in the language domain. Severely abnormal cUS findings and bronchopulmonary dysplasia were confirmed as independent risk factors for major sequelae.
