Predicting neurosensory disabilities at two years of age in a national cohort of extremely premature infants (original) (raw)
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Visual and Hearing Impairments After Preterm Birth
Pediatrics, 2018
Our aim was to determine and compare the incidences of sensory impairments among very preterm (VP) (<32 + 0/7 weeks), moderately preterm (MP) (32 + 0/7-33 + 6/7 weeks), late preterm (LP) (34 + 0/7-36 + 6/7 weeks), and term infants (≥37 weeks) and to establish risk factors of neurosensory disabilities. This national register study included all live-born infants in Finland between 1991 and 2008. Infants who died before the age of 1 year, who had any major congenital anomaly, or had missing data were excluded ( = 21 007; 2.0%). A total of 1 018 256 infants were analyzed. Incidences of hearing loss, visual disturbances or blindness, other ophthalmologic disorders, and retinopathy of prematurity were determined for gestational age (GA) groups. Risk factors of hearing loss and visual disturbances or blindness were analyzed. The incidences of sensory impairments decreased with advancing GA at birth ( < .001). The most prominent factors associated with increased risks of hearing loss ...
The effect of neurodevelopmental impairment definition on incidence rates among very preterm infants
2016
Background: Various criteria are used to define severe neurodevelopmental impairment (SNI) and the effect of definition is rarely reported. Objective: To examine the impact of changes in SNI definition on incidence rates of SNI and the association between risk factors and SNI. Methods: We included infants (n=2187) born <29 weeks gestation between April 2009 and September 2011, who were admitted to a Canadian Neonatal Network Neonatal Intensive Care Unit (NICU) and assessed at 18-21 months corrected age by the Canadian Neonatal Follow-Up Network (CNFUN). Incidence rates of SNI were calculated for 7 commonly used definitions identified in the literature. Logistic regression was performed to identify risk factors for SNI using the definitions which yielded the highest and the lowest incidence rate of SNI. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were estimated for risk factors significantly associated with SNI. Results: SNI definitions were composed of six common criteria: cerebral palsy severity using the Gross Motor Function Classification System (GMFCS), motor, language, and cognitive Bayley-III scores, and visual or hearing impairment. SNI incidence ranged from 3.5% to 14.9% (highest vs lowest rate ratio 4.29; 95% CI: 3.37, 5.47). The definition yielding the highest incidence included at least one of: GMFCS score 3-5, Bayley-III motor, language, or cognitive score <70, bilateral visual impairment, or use of hearing aids or cochlear implants. The definition yielding the lowest incidence included at least one of: GMFCS score 4-5, Bayley-III language or cognitive score <55, or bilateral visual impairment. The associations between risk factors and SNI varied depending on the SNI definition used. Maternal ethnicity, employment status, antenatal steroid treatment, and gestational age at birth were inconsistent in the significance of their associations with SNI. Maternal drug use, infant male sex, score of neonatal acute physiology >20, late onset sepsis, bronchopulmonary dysplasia, and intraventricular hemorrhage were consistently associated with SNI, irrespective of the SNI definition used, although the strength of these associations varied. Conclusions: Criteria used to define SNI significantly influence SNI incidence and the associations between risk factors and SNI. A standardized definition of SNI would facilitate scientific communication and spatio-temporal comparisons.
Neurosensory Outcome of Prematurely Born
2016
More and more survival of newborns with low birth weight (under 2500 g) or extremely small body mass at birth (under 1000 g), as well as increasing percent of prematurely born babies
Neurodevelopmental assessment of the newborn: An opportunity for prediction of outcome
Brain and Development, 2011
Over the decades, the evolution of neonatology has been a continuum. After intense focus on cardiac and respiratory support, now more time, effort and research are concerned about brain development of the term and preterm infants. There is no single standardized neurodevelopmental assessment tool that can be advocated for infants in the neonatal intensive care unit. The tools that are currently available vary in their physiological bases, pre requisite training and expertise, time allotted to perform and score, and clinical utility and validity. In this communication, we describe the neurobehavioral and sensory capabilities of the neonate. We then compare the commonly used neurobehavioral examinations with an emphasis on premature infants. We envision this effort as an essential step before the development of a universal and comprehensive assessment tool.
Visual function in 6 to 7 year-old children born extremely preterm: a population-based study
Acta Ophthalmologica, 2012
Purpose: Progress in neonatal care has caused an increased survival of children born extremely preterm. The aims of this study were to examine the long-term visual function and ocular development in an unselected cohort of extremely preterm infants and relate the results to neonatal morbidity and long-term neurodevelopmental outcome. Methods: All children with gestational age of 22-27 completed weeks or birth weight of 500-999 g born in the years 1999-2000 in two counties of Western Norway (n = 52) were invited to an eye examination that included visual acuity, refractive error, binocular function, accommodative amplitude and fundus examination. Cognitive function was assessed with the WPSSI-R test and motor abilities with the ABC movement test. Results: Neonatal morbidities and neurodevelopmental outcome were known for all, while 37 of the 52 children underwent the eye examination. None were blind or visually impaired, but 46% had subnormal visual acuity (logMAR ‡0.1). Ninety per cent were emmetropic or slightly hypermetropic (0 to +3D), while 10% had manifest and 51% latent strabismus. Performance IQ on the WPSSI-R test and ABC total score were associated with best visual acuity (p = 0.03 and p < 0.01, respectively). In a multiple linear regression model, visual acuity in the best eye was significantly associated with performance IQ (p = 0.03) and ABC total score (p = 0.02). Conclusion: This study suggests a more favourable long-term prognosis on important ocular and visual parameters in survivors of extreme prematurity than expected from similar reports on children born less prematurely and that performance IQ and motor function are related to visual acuity.
Journal of Advances in Medicine and Medical Research
Introduction: The incidence of pre term delivery and the survival rate of preterm babies is rising due to new medical technologies. In developing countries, very low birth weight (BW) babies less than 32 weeks of gestational age (GA) have a high risk for neuro-developmental retardation. They need to be followed up at regular intervals so as to assess various morbidities they develop during hospital stay as also post discharge and neurodevelopment outcome for early stimulation. Methods: Follow up schedule of <32 weeks neonates is every 15 days till 3 months than every monthly for one year than 3 monthly till 2 years of age. The evaluation consisted of neurological assessments, cranial ultrasounds and developmental assessments. Results and Discussion: The study was completed with 69 babies. Male & female ratio was 1.3:1. In our study 62.3% were SGA babies. Convulsion was most common morbitiy 75.3%. Many of the tone abnormalities detected in the first six months in high risk infants...
The Journal of pediatrics, 2018
To assess the impact of variations in the definition of severe neurodevelopmental impairment (NDI) on the incidence of severe NDI and the association with risk factors using the Canadian Neonatal Follow-Up Network cohort. Literature review of severe NDI definitions and application of these definitions were performed in this database cohort study. Infants born at 23-28 completed weeks of gestation between 2009 and 2011 (n = 2187) admitted to a Canadian Neonatal Network neonatal intensive care unit and assessed at 21 months' corrected age were included. The incidence of severe NDI, aORs, and 95% CIs were calculated to express the relationship between risk factors and severe NDI using the definitions with the highest and the lowest incidence rates of severe NDI. The incidence of severe NDI ranged from 3.5% to 14.9% (highest vs lowest rate ratio 4.29; 95% CI 3.37-5.47). The associations between risk factors and severe NDI varied depending on the definition used. Maternal ethnicity, ...
Acta Paediatrica, 1998
A prospective national investigation comprising 633 extremely low birthweight (ELBW) infants born alive in the 2-y period 1990-1992 with a birthweight of Յ1000 g and gestational age of Ն23 completed weeks was conducted regarding neurosensory outcome and growth. Three-hundred and sixty-two (98%) surviving ELBW infants were assessed at a median age of 36 months, using a specially designed protocol. At followup, mean height, weight and head circumference in both boys and girls were significantly lower than the reference values. The incidence of cerebral palsy was 7% among all children and 14%, 10% and 3% in children born at 23-24, 25-26 and Ն27 gestational weeks, respectively. At least one obvious handicap was present in 14%, 9% and 3% of these three groups of children, respectively. After adjustment for gestational age, a significantly increased risk of handicap was found in children with intraventricular haemorrhage grade Ն3 and/or periventricular leucomalacia and in children with retinopathy of prematurity stage Ն3. The results show that more than 90% of ELBW children born at Ն25 completed gestational weeks were without neurosensory handicap at 36 months of corrected age. In infants born at 23-24 weeks of gestation, both survival and long-term outcome were less favourable. ٖCerebral palsy, extremely low birthweight children, growth at 36 months, neurosensory outcome O Finnström,
Neurodevelopmental outcomes following late and moderate prematurity: a population-based cohort study
Archives of disease in childhood. Fetal and neonatal edition, 2015
There is a paucity of data relating to neurodevelopmental outcomes in infants born late and moderately preterm (LMPT; 32(+0)-36(+6) weeks). This paper present the results of a prospective, population-based study of 2-year outcomes following LMPT birth. 1130 LMPT and 1255 term-born children were recruited at birth. At 2 years corrected age, parents completed a questionnaire to assess neurosensory (vision, hearing, motor) impairments and the Parent Report of Children's Abilities-Revised to identify cognitive impairment. Relative risks for adverse outcomes were adjusted for sex, socio-economic status and small for gestational age, and weighted to account for over-sampling of term-born multiples. Risk factors for cognitive impairment were explored using multivariable analyses. Parents of 638 (57%) LMPT infants and 765 (62%) controls completed questionnaires. Among LMPT infants, 1.6% had neurosensory impairment compared with 0.3% of controls (RR 4.89, 95% CI 1.07 to 22.25). Cognitive...
Acta Paediatrica, 2001
The aim of this study was to measure brainstem size on magnetic resonance imaging (MRI) scans of high-risk, preterm infants, to assess brainstem function by brainstem auditory-evoke d potentials (BAEP) and to determine the predictive value of these measures for the neurosensory outcome. A total of 51 preterm infants (gestational age <34 wk, birthweight <1500 g) underwent examinations at term age; neuromotor outcome and hearing were followed up until a corrected age of 18 mo. Fourteen (27%) infants had neurosensory disability. Those with a later neurosensory disability had a signi cantly smaller brain stem than those with a normal outcome. The preterm infants had signi cantly longer peak latency (L) V and interpeak latency (IPL) III-V than the full-term control infants. Most of the preterm infants with severe cerebral palsy or hearing loss had abnormal BAEP. Sensitivity of morphometric dimensions for predicting neurosensory disability was only 20-31%, but speci city was 97-100%. Abnormal L I and IPL III-V in BAEP predicted disability with a sensitivity of 93% and a speci city of 57-59%. Conclusion: We conclude that adverse events during the perinatal period may lead to morphofunctional changes in the brain stem in high-risk, preterm infants, and it seems that functional changes are accurate in predicting neurosensory disability in such patients.