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Intermittent Hypoxemia and Neurodevelopmental Impairment at 12 and 24 Months in Preterm Infants
Juliann M Di Fiore1, Deanne Wilson-Costello1, Zhengyi Chen2
1Department of Pediatrics, UH Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
Neonatology
|May 26, 2025
Summary
Intermittent hypoxemia (IH) in preterm infants is linked to neurodevelopmental impairment (NDI) at 12 and 24 months. This risk is more pronounced in infants born at or after 29 weeks gestation.
Area of Science:
- Neonatal Medicine
- Neurodevelopmental Pediatrics
- Pediatric Critical Care
Background:
- Intermittent hypoxemia (IH) in neonates is associated with long-term adverse outcomes.
- Previous studies on IH and neurodevelopmental impairment (NDI) used varied definitions and cohorts.
- This study investigated IH exposure in a wider gestational age range of preterm infants.
Purpose of the Study:
- To determine the association between intermittent hypoxemia (IH) exposure and neurodevelopmental impairment (NDI) in preterm infants.
- To examine this relationship at 12 and 24 months corrected age using multiple IH thresholds.
- To explore if IH is a risk factor for NDI in preterm infants.
Main Methods:
- Documented IH (oxygen saturation <80% or <90%) in preterm infants (<31 weeks gestation) from day 8 to 28 of life (n=175).
- Assessed NDI using the Ages and Stages Questionnaire (ASQ-3) at 12 and 24 months corrected age.
- Referral for NDI was defined as scores >2 SD below the mean in any developmental domain (gross motor, communication, fine motor, problem solving, personal-social).
Main Results:
- Unadjusted analyses showed significant associations between increased IH and referral scores for gross motor and communication skills at 12 months, and all domains at 24 months.
- Adjusted models indicated that higher % time with oxygen saturation <90% was significantly associated with communication skill referral scores at 12 months (p=0.0158).
- Subgroup analyses revealed associations between higher % time <80% (12 months) or longer IH duration <90% (24 months) and referral scores for any domain in infants born at or after 29 weeks gestation.
Conclusions:
- A limited relationship was observed between IH and ASQ-3 referral scores for NDI overall.
- An association between IH and ASQ-3 referral for NDI was found at 12 and 24 months in infants born at or after 29 weeks gestation.
- Intermittent hypoxemia may be a risk factor for NDI in older preterm infants with fewer competing morbidities.
