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Updated: May 16, 2025

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Risk Factor Effects on Neurodevelopment at 2 Years in Very Preterm Children: A Systematic Review

Samuel B Axford1,2,3, Alice C Burnett1,2,4, Abdulbasit M Seid2,5

  • 1Department of Paediatrics, The University of Melbourne, Melbourne, Australia.

Pediatrics
|May 14, 2025
PubMed

Insights

Neurologic morbidities like brain injury significantly increase neurodevelopmental impairment (NDI) risk in very preterm infants. Consistent definitions are crucial for future research on these critical factors.

Area of Science:

  • Neonatal Medicine
  • Developmental Pediatrics
  • Neuroscience

Background:

  • Adverse neurodevelopment in very preterm infants is linked to various medical and social factors.
  • Quantifying these effects requires analyses that account for confounders in representative samples.

Purpose of the Study:

  • To systematically review risk factors impacting neurodevelopmental impairment (NDI) in infants born before 32 weeks' gestation.
  • To assess NDI at 18 to 36 months of age in this vulnerable population.

Main Methods:

  • Systematic review of Ovid MEDLINE, Embase, and PubMed databases up to April 29, 2024.
  • Inclusion of geographic or network population cohort studies of infants born <32 weeks' gestation since 1990.
  • Exclusion of studies with <50 children, lacking confounder analysis, or nonrepresentative samples.

Main Results:

  • Brain injury (IVH grade III/IV, PVL) showed the highest odds of moderate-to-severe NDI.
  • Neonatal seizures and retinopathy of prematurity (≥stage 3) were also significant risk factors.
  • Small for gestational age had inconsistent effects; lower maternal age showed no effect.

Conclusions:

  • Neurologic morbidities confer the highest risk for NDI in very preterm infants.
  • Heterogeneity in factor and outcome definitions prevented meta-analysis.
  • Consistent definitions are needed for future research on risk factors and NDI.
Abstract

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