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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurosensory, cognitive and academic outcomes at 8 years in children born 22-23 weeks' gestation compared with more
India Rm Marks1, Lex W Doyle1,2,3,4, Rheanna M Mainzer4,5
1Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Insights
Infants born extremely preterm at 22-23 weeks
Area of Science:
- Neonatalogy and Developmental Pediatrics
- Neuroscience and Child Development
- Public Health and Epidemiology
Background:
- Intensive care for infants born before 24 weeks' gestation has increased.
- Data on school-age outcomes for these infants are limited, impacting counseling and decision-making.
Purpose of the Study:
- To compare neurosensory, cognitive, and academic impairments in school-aged children born extremely preterm (22-23 weeks' gestation) versus those born at 24-27 weeks and term.
- To inform clinical practice and parental counseling regarding outcomes for extremely preterm infants.
Main Methods:
- Prospective longitudinal study of three cohorts: extremely preterm (22-27 weeks' gestation) and term-born infants.
- Assessment at 8 years of age for major neurosensory disability, motor, cognitive, academic impairment, executive dysfunction, and health utility.
- Statistical analysis using generalized linear models to estimate risk ratios and differences, adjusted for confounding factors.
Main Results:
- Children born at 22-23 weeks' gestation had a higher risk of major neurosensory disability compared to more mature groups, with risk increasing with later gestational age.
- Similar trends of increased impairment were observed across motor, cognitive, and academic outcomes.
- Notably, two-thirds of survivors born at 22-23 weeks' gestation were free from major neurosensory disability.
Conclusions:
- While infants born at 22-23 weeks' gestation face higher rates of disability and impairment, a significant proportion achieve positive outcomes.
- These findings support the continuation and provision of active intensive care for infants born at the earliest gestations.
- The study provides crucial data for counseling families regarding the potential outcomes for extremely preterm infants.
Abstract:
Despite providing intensive care to more infants born <24 weeks' gestation, data on school-age outcomes, critical for counselling and decision-making, are sparse.
Objective:
To compare major neurosensory, cognitive and academic impairment among school-aged children born extremely preterm at 22-23 weeks' gestation (EP22-23) with those born 24-25 weeks (EP24-25), 26-27 weeks (EP26-27) and term (≥37 weeks).
Design:
Three prospective longitudinal cohorts.
Setting:
Victoria, Australia.
Participants:
All EP live births (22-27 weeks) and term-born controls born in 1991-1992, 1997 and 2005.
Main Outcome Measures:
At 8 years, major neurosensory disability (any of moderate/severe cerebral palsy, IQ <-2 SD relative to controls, blindness or deafness), motor, cognitive and academic impairment, executive dysfunction and poor health utility. Risk ratios (RRs) and risk differences between EP22-23 (reference) and other gestational age groups were estimated using generalised linear models, adjusted for era of birth, social risk and multiple birth.
Results:
The risk of major neurosensory disability was higher for EP22-23 (n=21) than more mature groups (168 EP24-25; 312 EP26-27; 576 term), with increasing magnitude of difference as the gestation increased (adjusted RR (95% CI) compared with EP24-25: 1.39 (0.70 to 2.76), p=0.35; EP26-27: 1.85 (0.95 to 3.61), p=0.07; term: 13.9 (5.75 to 33.7), p<0.001). Similar trends were seen with other outcomes. Two-thirds of EP22-23 survivors were free of major neurosensory disability.
Conclusions:
Although children born EP22-23 experienced higher rates of disability and impairment at 8 years than children born more maturely, many were free of major neurosensory disability. These data support providing active care to infants born EP22-23.
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