Borradori-Tolsa, C., Hasler, T., Sancho-Rossignoli, A., & Huppi, P. S. (2005).
52 longitudinal neurodevelopmental outcome at 18 months and 5 years
in infants born <32 weeks of GA. Pediatric Research, 58, 363-363.
BACKGROUND: Children born preterm have a high prevalence of neurologic and developmental disabilities in the first two years of live. Their predictibility for developmental problems at 5 years of age is unclear.
AIMS: 1)to assess the neurological and developmental outcome at 18 months and 5 years of age in a regionally defined cohort of preterm infants born less than 32 weeks GA. 2)To investigate the effects of prematurity and growth impairment on later motor and cognitive development.
METHODS: Perinatal data were collected retrospectively on a cohort from January 1996 through December 1996. Growth, neurological examination and development were evaluated at 18 months and 5 years of age. Psychomotor development at corrected age 18 months was assessed using the Bayley Scales of Infant Development (MDI/PDI). At 5 years, cognitive function was assessed with the Kaufman Assessment Battery for Children (K-ABC).
RESULTS: Of 54 surviving children, 45 (83%) underwent neurological and developmental assessment by age 18 months. The rates of CP, minor neurological impairment, hearing impairment, visual impairment were 7%, 20%, 7%, 2% respectively. The mean MDI and PDI scores were 94.5±24.2 and 87.8±21.2 respectively. The neonatal factors significantly associated with neurodevelopmental disability at 18 months of age were BPD (p<0.01) and neonatal infection (p<0.05). Severe cranial ultrasounds abnormalities (PVL, IVH grade 3/4) were present only in one infant. Children with MDI<85 had significantly smaller had circumference at birth and still at 18 months of corrected age (both p<0.05). At 5 years of age, the followed 38 children born in 1996 (70% of survivors), scored within the normal range on all subscales of the K-ABC, but children with BW < 1000g exhibited lower general cognitive ability (MCP: 82.1±12.9,vs 95.2±14.8, p=0.05) and scored significantly below the norm in the sequential processing scale (SP: 82.4±6.1,vs 97.9±12.9, p<0.01). Neonatal factors like a smaller head circumference at birth, a higher incidence of neonatal infection and poor post-natal growth correlated negatively with cognitive development (p<0.01, p<0.05, p<0.05 respectively). Children with MCP<85 had already significantly lower MDI scores at 18 months than children who scored within the normal limits (83±20.9 vs 102±19.5, p<0.05)
CONCLUSION: This study provides outcome data for a geographically defined cohort. BPD and neonatal infection were associated with neurodevelopmental disability at 18 months of age. Poor postnatal growth and delayed development at the age of 18 months were predictive of cognitive impairment at 5 years of age.