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Prediction of lower developmental performances of healthy neonates by neonatal EEG-sleep measures
M S Scher1, D A Steppe, D L Banks
1Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Insights
Healthy preterm infants show developmental delays compared to term infants, particularly in mental and motor skills. These differences diminish with age adjustment, highlighting the importance of considering prematurity in developmental assessments.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatrics
Background:
- Altered electroencephalogram (EEG)-sleep patterns observed in healthy preterm infants at term-equivalent age compared to term infants.
- Previous studies indicated potential neurophysiologic differences impacting development.
Purpose of the Study:
- To compare developmental outcomes between healthy preterm and term infants at 12 and 24 months of age.
- To investigate the association between neonatal EEG-sleep measures and later cognitive development in preterm infants.
Main Methods:
- Developmental assessments (Bayley Scales, Vineland, Carey Temperament) were conducted on 16 preterm and 16 term infants.
- Multivariate Analysis of Variance (MANOVA) was used for cohort comparisons.
- Regression analyses examined the relationship between neonatal EEG-sleep variables and 12/24-month Bayley mental scores.
Main Results:
- Preterm infants scored lower on Bayley mental and motor scales at 12 and 24 months before age adjustment (P < .0001 and P < .04).
- No significant group differences were found after age adjustment.
- Neonatal EEG-sleep characteristics (e.g., spectral EEG energy in beta range, arousals, REM) were associated with 12/24-month Bayley mental scores.
- Lower socioeconomic status correlated with lower developmental scores.
Conclusions:
- Brain adaptation to prematurity, even without major illness, affects later development.
- Age-equivalent adjustment is crucial for assessing development in healthy preterm infants up to 24 months.
- Specific neonatal EEG-sleep patterns may predict cognitive outcomes in preterm infants.
Abstract:
Previous neurophysiologic studies from our laboratory have demonstrated altered EEG-sleep behavior at conceptional term ages in healthy preterm infant compared with a term cohort. Developmental assessments at 12 and 24 months of age of 16 children in each cohort were compared using MANOVA. Differences were detected on MANOVA between each cohort on Bayley mental and motor performance scores, while social skills (Vineland) and temperament (Carey) were similar. Healthy preterm infants had lower scores at 12 months of age (P < .0001) and 24 months (P < .04) than term infants before adjustment for prematurity. No group differences were observed after adjustment. For the combined cohort of 32 healthy neonates, specific neonatal EEG-sleep measures were included as predictor variables in regression analyses with Bayley mental scores as outcome variables. Lower Bayley mental scores at 12 and 24 months were associated with higher spectral EEG correlations, lower spectral EEG energies in the beta frequency ranges, fewer arousals per minute, lower rapid eye movements per minute, and shorter sleep latencies from awake state to active sleep. Significant associations were observed before adjustment for prematurity at both 12 and 24 months, and after adjustment at 12 months of age for lower spectral beta EEG energies. Lower socioeconomic class also correlated with lower developmental scores. Even in the absence of major neonatal illnesses, brain adaptation to prematurity influences later developmental outcome. Adjustment for "age equivalency" may be required up to at least 24 months of age even in a healthy preterm population.