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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Predicting long-term neurodevelopmental outcomes for children born very preterm: a systematic review
Alice Burnett1,2,3,4, Samuel B Axford2,3,4, Abdulbasit M Seid2,5
1Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia.
Insights
Children born very preterm face higher risks for neurodevelopmental issues. Key predictors include brain injury, bronchopulmonary dysplasia, male sex, and lower socioeconomic status, guiding early intervention strategies.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Neuroscience
Background:
- Children born very preterm (<32 weeks' gestation) exhibit elevated risks for neurodevelopmental difficulties compared to term-born infants.
- Identifying specific early risk factors for later childhood challenges is crucial for timely intervention and family support.
Purpose of the Study:
- To systematically review and synthesize evidence on early medical and environmental factors influencing neurodevelopmental impairment, cognitive, motor, and behavioral outcomes in very preterm children.
Main Methods:
- A comprehensive search of Ovid MEDLINE, Embase, and PubMed was conducted for prospective cohort studies published between January 1990 and April 2024.
- Included studies focused on children born <32 weeks' gestation, assessing outcomes at 36 months to 18 years.
- Data extraction was descriptive due to heterogeneity in outcome measures.
Main Results:
- Twenty-nine studies from 16 cohorts were analyzed, identifying brain injury, bronchopulmonary dysplasia, male sex, and lower socioeconomic status as consistent predictors of neurodevelopmental impairment.
- These factors were associated with outcomes including lower IQ, impaired working memory, cerebral palsy, and certain behavioral measures.
- Emotional problems showed no significant association with the investigated neonatal variables.
Conclusions:
- Multiple factors independently predict childhood outcomes in very preterm children, with specific predictors varying by functional domain.
- Understanding these predictors is vital for targeted surveillance and early intervention programs for high-risk infants.
- Further research is needed to clarify predictor-outcome combinations with limited current evidence.
Context:
Children born very preterm (<32 weeks' gestation) have increased risk of neurodevelopmental difficulties compared with those born at term. While various neonatal exposures have been linked with later developmental challenges, identifying those at risk of difficulties later in childhood remains a challenge but is essential for targeting early intervention and counselling families.
Objective:
To systematically review and synthesise the evidence regarding early medical and environmental factors for neurodevelopmental impairment, cognitive, motor and behavioural outcomes for children born very preterm.
Design:
Ovid MEDLINE, Embase and PubMed were searched for articles between 1 January 1990 and 29 April 2024 reporting on a representative, prospective geographical, network-based or multisite cohorts of children born <32 weeks' gestation.
Main Outcome Measures:
Neurodevelopmental impairment, cognitive, motor and emotional-behavioural functioning in children aged 36 months to 18 years. Data were extracted and reported descriptively due to heterogeneity in study measures.
Results:
From 18 012 records, 29 studies from 16 cohorts were included. Brain injury, bronchopulmonary dysplasia, male sex and lower socioeconomic status were the most consistent predictors of neurodevelopmental impairment, IQ, working memory, cerebral palsy, fine motor skills and some behavioural measures. Emotional problems were generally not associated with neonatal variables investigated to date.
Conclusion:
Numerous factors are independently associated with childhood outcomes after being born very preterm, with specific predictors varying across domains of functioning and limited available evidence for some predictor-outcome combinations. Knowledge of these factors may assist in targeting those at highest risk for closer surveillance and early intervention.PROSPERO registration numberCRD42022368957.
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