Early Neurological Assessment and Long-Term Neuromotor Outcomes in Late Preterm Infants: A Critical Review.

Domenico M Romeo,Giorgia Cordaro,Eugenio Mercuri,Maria Picilli,Martina Ricci,Benedetta Foti

doi:10.3390/medicina56090475

Abstract

Background and Objectives: Late preterm (LP) infants (born between 34 and 36 weeks of gestational age) are considered at higher risk of neonatal morbidities, mortality, and neurological impairments than full-term born infants (FT). The aim of this study was to provide a critical review of the literature outlining the different aspects of neurological function reported both in the neonatal period and in the follow up of late preterm infants. Materials and Methods: A comprehensive search of the MEDLINE, Embase, PsycINFO, and CINAHL electronic databases was made, using the following search terms: ‘Late preterm infants’, ‘Near term infants’, ‘neurological assessment’, ‘neurological outcome’, ‘neuromotor outcome’, cerebral palsy’, ‘CP’, ‘motor impairment’, including all the studies reporting clinical neurological assessment of LP (including both neonatal period and subsequent ages). Results: A total of 35 articles, comprising 301,495 children, were included as fulfilling the inclusion criteria: ten reported neonatal neurological findings, seven reported data about the first two years after birth, eighteen reported data about incidence of CP and motor disorder during the infancy. Results showed a more immature neurological profile, explored with structured neurological assessments, in LP infants compared with FT infants. The LP population also had a higher risk of developing cerebral palsy, motor delay, and coordination disorder. Conclusion: LP had a higher risk of neurological impairments than FT infants, due to a brain immaturity and an increased vulnerability to injury, as the last weeks of gestational age are crucial for the development of the brain.

Highlights

Late preterm (LP) infants are defined as infants born between 34 and 36 weeks of gestational age, and represent the predominant part of infants born prematurely (~70%) [1,2,3].In literature, they are described as at a relatively low risk of neuromotor impairments compared with other preterm infants born at a lower gestational age and they are often not routinely followed
The remaining 35 articles, comprising a total of 301,495 children, met the inclusion criteria after a review of the full text including the neurological assessments in LP infants (Figure 1)
When examined at term age, infants born at 34 weeks had a more immature profile, in particular in the tone items, as limb flexor tone and head control, Moro reflex and visual orientation, than those born at the age of 35–36 who have a neurological profile similar to full-term (FT) born infants

Summary

Introduction

Late preterm (LP) infants are defined as infants born between 34 and 36 weeks of gestational age, and represent the predominant part of infants born prematurely (~70%) [1,2,3].In literature, they are described as at a relatively low risk of neuromotor impairments compared with other preterm infants born at a lower gestational age and they are often not routinely followed. Specific Learning Disorder [2], developmental delay or mental retardation [4,5,6,7,8], psychiatric disorders like schizophrenia [8], and worse social competence compared to full-term infants [9]. This is true even in the absence of brain lesions, showing that prematurity per se is a risk factor for neurodevelopmental disease [7]. Late preterm (LP) infants (born between 34 and 36 weeks of gestational age) are considered at higher risk of neonatal morbidities, mortality, and neurological impairments than full-term born infants (FT). Conclusion: LP had a higher risk of neurological impairments than FT infants, due to a brain immaturity and an increased vulnerability to injury, as the last weeks of gestational age are crucial for the development of the brain

Objectives

Methods

Results

Discussion

Conclusion