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Two-year neurodevelopmental outcome in extremely preterm-born children: The Austrian Preterm Outcome Study Group
Ursula Kiechl-Kohlendorfer1, Burkhard Simma2, Angelika Berger3
1Department of Paediatrics II (Neonatology), Medical University Innsbruck, Innsbruck, Austria.
Insights
This study tracked extremely preterm infants, finding 22% had moderate-to-severe neurodevelopmental impairment by age two. Outcomes improved with longer gestation, but neonatal complications increased impairment risk.
Area of Science:
- Neonatology
- Developmental Pediatrics
- Public Health
Background:
- Extremely preterm infants face significant risks for neurodevelopmental impairment.
- Understanding long-term outcomes is crucial for parental counseling and resource allocation.
Purpose of the Study:
- To determine the neurodevelopmental outcome at 2 years corrected age in extremely preterm infants born in Austria.
- To identify factors associated with neurodevelopmental impairment in this cohort.
Main Methods:
- Prospective registry of live-born infants 23-27 weeks gestation (2011-2020).
- Neurodevelopmental assessment at 2 years corrected age using Bayley Scales, neurological examination, and neurosensory function evaluation.
- Multivariate analysis to identify risk factors.
Main Results:
- 81.9% survival to 2 years corrected age; follow-up data available for 62.6%.
- Overall, 22.0% had moderate-to-severe neurodevelopmental impairment.
- Impairment decreased with increasing gestational age (31.4% at 23 weeks to 16.5% at 27 weeks).
- Neonatal complications and male sex were associated with increased impairment risk.
Conclusions:
- A significant proportion of extremely preterm infants experience moderate-to-severe neurodevelopmental impairment.
- Gestational age is a key determinant of neurodevelopmental outcome.
- National data on neurodevelopmental impairment are vital for healthcare planning and parental support.
Aim:
The current study determined the neurodevelopmental outcome of extremely preterm infants at 2 years of age.
Methods:
All live-born infants 23-27 weeks of gestation born between 2011 and 2020 in Austria were included in a prospective registry. Neurodevelopmental outcome at 2 years of corrected age was assessed using Bayley Scales of Infant Development for both motor and cognitive scores, along with a neurological examination and an assessment of neurosensory function.
Results:
2378 out of 2905 (81.9%) live-born infants survived to 2 years of corrected age. Follow-up data were available for 1488 children (62.6%). Overall, 43.0% had no, 35.0% mild and 22.0% moderate-to-severe impairment. The percentage of children with moderate-to-severe neurodevelopmental impairment decreased with increasing gestational age and was 31.4%, 30.5%, 23.3%, 19.0% and 16.5% at 23, 24, 25, 26 and 27 weeks gestational age (p < 0.001). Results did not change over the 10-year period. In multivariate analysis, neonatal complications as well as male sex were significantly associated with an increased risk of neurodevelopmental impairment.
Conclusion:
In this cohort study, a 22.0% rate of moderate-to-severe neurodevelopmental impairment was observed among children born extremely preterm. This national data is important for both counselling parents and guiding the allocation of health resources.
