Are Neurodevelopmental Outcomes of Infants Born Extremely Preterm Improving Over Time?

Abstract

* Abbreviations: Bayley-III — : Bayley Scales of Infant and Toddler Development, Third Edition NDI — : neurodevelopmental impairment NRN — : Neonatal Research Network Accurate data on rates of mortality and of neurodevelopmental impairment (NDI) in survivors are critical in decision-making for infants born at 22 to 24 weeks’ gestation, the borderline of viability. Despite many studies reporting on mortality and NDI rates, it is concerning that health care professionals continue to overestimate rates of mortality and NDI of infants at the borderline of viability.1 Because survival rates may have plateaued in recent years,2 there is an increasing emphasis on their rates of NDI. In the current issue of Pediatrics , Adams-Chapman et al3 from the Neonatal Research Network (NRN) hypothesized that NDI in children born at <27 completed weeks’ gestation would decrease over a 3.75-year period beginning in 2011. The authors reported on neurodevelopmental outcomes at 18 to 26 months’ corrected age for 2113 children who had been born and cared for in an NRN center and who were involved in the NRN’s follow-up study. NDI comprised any of the following: gross motor impairment as defined by using a Gross Motor Function Classification System4 of level 2 or more; a Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III)5 cognitive or motor score <70; bilateral blindness; or hearing impairment. The rate of NDI did … Address correspondence to Lex W. Doyle, MD, MSc, FRACP, Research Precinct, Level 7, The Royal Women’s Hospital, 20 Flemington Rd, Parkville, VIC 3052, Australia. E-mail: lwd{at}unimelb.edu.au