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Extremely low birthweight infants at 3 years: a developmental profile
J R Bowen1, D R Starte, J D Arnold
1Department of Neonatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Insights
Most extremely low birthweight survivors show normal development by age 3. However, neurologically normal children often have weaker eye-hand coordination, suggesting tailored preschool programs for these extremely low birthweight (ELBW) survivors are beneficial.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Neuroscience
Background:
- Extremely low birthweight (ELBW) survivors face significant neurodevelopmental challenges.
- Long-term outcomes and specific developmental profiles of ELBW infants require further investigation.
Purpose of the Study:
- To document the neurodevelopmental outcome at 3 years in ELBW survivors.
- To analyze the developmental profile of neurologically normal ELBW children.
Main Methods:
- Follow-up study of 52 ELBW survivors at 3 years of age.
- Assessment using Griffiths Scales to evaluate neurodevelopmental impairment and general quotient (GQ).
- Identification of risk factors associated with severe neurodevelopmental impairment.
Main Results:
- 67% of ELBW survivors had normal development (GQ ≥ 85) at 3 years.
- Severe impairment (cerebral palsy, blindness, deafness, GQ < 70) occurred in 12% of survivors.
- Risk factors for severe impairment included retinopathy of prematurity, postnatal steroid treatment, intraventricular hemorrhage, and supplemental oxygen at term.
- Neurologically normal survivors demonstrated relative strengths in hearing and speech, with weaknesses in eye-hand coordination.
Conclusions:
- A majority of ELBW survivors achieve normal development by age 3.
- Specific developmental patterns, such as impaired eye-hand coordination in normal survivors, necessitate targeted early intervention.
- Early identification of these developmental profiles can inform the design of effective preschool programs for ELBW children.
Abstract:
This study documents the neurodevelopmental outcome at 3 years of 52 of 55 extremely low birthweight (ELBW) survivors (survival rate 49%) born in a tertiary maternity centre from July 1985 through December 1988, and examines more closely the developmental profile of the neurologically normal survivors. At 3 years, 6 (12%) children had severe neurodevelopmental impairment (severe cerebral palsy, blindness, deafness or a General Quotient (GQ) < 70 on the Griffiths Scales), 11 (21%) had mild to moderate impairment and 35 (67%) had no neurosensory impairment and normal development (GQ > or = 85). Significant risk factors for severe impairment were stage 3 or 4 retinopathy of prematurity (odds ratio [OR] 21.5), treatment with postnatal steroids (OR 21), grade III or IV intraventricular haemorrhage (OR 11) and supplemental oxygen at 'term' (OR 6.4). The developmental profile of the 35 neurologically normal children revealed a significant weakness in eye and hand coordination skills and a relative strength in hearing and speech skills. Early recognition of this developmental profile may allow implementation of more appropriate preschool programmes for ELBW children.