Age-appropriate early school age neurobehavioral outcomes of extremely preterm birth without severe intraventricular hemorrhage: A single center experience

Abstract

Background Extremely low birth weight (ELBW) is an established risk factor for poor neurocognitive outcome, particularly when severe intraventricular hemorrhage (IVH) complicates the neonatal course. Those born < 26 weeks gestational age (GA) are at greatest risk, their outcomes poorer than later born ELBW children. Outcomes of GA subgroups of ELBW uncomplicated by severe IVH have not been well described. Aim To compare neurocognitive and behavioral outcomes of those born < and ≥ 26 weeks for an ELBW cohort treated in a single center with extremely low IVH incidence. Design Single center retrospective observational cohort study of ≤ 1000 g survivors born between 1998–2000, using standardized tests of cognition, academic achievement, executive function, attention, language, memory, motor/visual–motor skill, parent and teacher behavioral questionnaires. Results ELBW participants (mean age: 6.85 ± 0.79) had a mean General Cognitive Ability of 101.4 ± 13.05; no significant differences found between < 26 weeks (98.19 ± 12.48) and ≥ 26 weeks (102.97 ± 13.21) subgroups. No neurocognitive, achievement, or behavioral score was impaired (≥ 2 SDs below the normative mean). Subgroup comparisons were nonsignificant after controlling for BW and maternal education, except for ≥ 26 week advantage for phoneme analysis. Poorer, but low average, performances were found for motor dexterity/coordination, spatial working memory, and selective attention. Conclusions Age-appropriate neurocognitive and behavioral function of ELBW survivors suggests outcome may be predicted based on IVH incidence as opposed to birth weight or GA. Factors leading to decreased IVH incidence deserve further study, via single- and cross-center methodologies, to enhance decision-making regarding resuscitation and care of these highly at-risk neonates.