Moderately and Late Preterm Infants: Short- and Long-Term Outcomes From a Registry-Based Cohort.

Nikoletta Smyrni,Maria Gontika,Helen Skouteli,Fotini Davora,Sotiria Mastroyianni,Zoi Dalivigka,Marianna Petra,Helen Strataki,Eirini Nikaina,Argyris Dinopoulos,Helen Bouza,George Damianos,Margarita Tzaki,Antigone Papavasiliou,Maria Koutsaki

doi:10.3389/fneur.2021.628066

Abstract

Background: While most studies on the association of preterm birth and cerebral palsy (CP) have focused on very preterm infants, lately, attention has been paid to moderately preterm [32 to <34 weeks gestational age (GA)] and late preterm infants (34 to <37 weeks GA).Methods: In order to report on the outcomes of a cohort of moderately and late preterm infants, derived from a population-based CP Registry, a comparative analysis of data on 95 moderately preterm infants and 96 late preterm infants out of 1,016 with CP, was performed.Results: Moderately preterm neonates with CP were more likely to have a history of N-ICU admission (p = 0.001) and require respiratory support (p < 0.001) than late preterm neonates. Birth weight was significantly related to early neonatal outcome with children with lower birth weight being more likely to have a history of N-ICU admission [moderately preterm infants (p = 0.006)/late preterm infants (p < 0.001)], to require ventilator support [moderately preterm infants (p = 0.025)/late preterm infants (p = 0.014)] and not to have neonatal seizures [moderately preterm infants (p = 0.044)/late preterm infants (p = 0.263)]. In both subgroups, the majority of children had bilateral spastic CP with moderately preterm infants being more likely to have bilateral spastic CP and less likely to have ataxic CP as compared to late preterm infants (p = 0.006). The prevailing imaging findings were white matter lesions in both subgroups, with statistically significant difference between moderately preterm infants who required ventilator support and mainly presented with this type of lesion vs. those who did not and presented with gray matter lesions, maldevelopments or miscellaneous findings. Gross motor function was also assessed in both subgroups without significant difference. Among late preterm infants, those who needed N-ICU admission and ventilator support as neonates achieved worse fine motor outcomes than those who did not.Conclusions: Low birth weight is associated with early neonatal problems in both moderately and late preterm infants with CP. The majority of children had bilateral spastic CP and white matter lesions in neuroimaging. GMFCS levels were comparable in both subgroups while BFMF was worse in late preterm infants with a history of N-ICU admission and ventilator support.

Highlights

Prematurity is highly associated with neonatal mortality and morbidity and constitutes a well-recognized risk factor for cerebral palsy (CP) and other lifelong effects on neurodevelopmental functioning and childhood/adulthood morbidity
Within the population of moderately preterm infants, of the 94/95 infants with available data concerning the need for neonatal intensive care unit (N-ICU) admission ninety six percent (96%) had a history of N-ICU admission, of the 86/95 infants with available data concerning the need for respiratory support eighty four percent (84%) underwent endotracheal intubation or continuous positive airway pressure (CPAP) ventilation and of the 72/95 infants with available data concerning the history of neonatal seizures eleven percent (11%) presented with seizures during the first 72 h after birth
Birth weight was significantly related to early neonatal outcome with both moderately and late preterm infants with lower birth weight being more likely to have a history of N-ICU admission [32 to

Summary

Introduction

Prematurity is highly associated with neonatal mortality and morbidity and constitutes a well-recognized risk factor for cerebral palsy (CP) and other lifelong effects on neurodevelopmental functioning and childhood/adulthood morbidity. Given that the last few weeks of gestation prepare the fetus for the transition from the intra-uterine life, the causes of respiratory distress observed in neonates even born after 32 weeks GA originate from the inability to adapt to the extrauterine environment due to immature lung structure [7, 10]. Neonatal seizures constitute another common complication in the newborn period. While most studies on the association of preterm birth and cerebral palsy (CP) have focused on very preterm infants, lately, attention has been paid to moderately preterm [32 to

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