Neurodevelopmental Outcome in Extremely Low Birth Weight Infants at 2-3 Years of Age.

Maria Kyriakidou,Ilias Chatziioannidis,Sofia Lampropoulou,Georgios Mitsiakos,Abraham Pouliakis

doi:10.3390/medicina56120649

Abstract

Background and objectives: The aims of this study were to examine the relationship between neurological outcomes at 3- and 6-months corrected age with the neurodevelopmental outcome at 3 years of age; to identify the perinatal/neonatal risk factors for poor neurodevelopmental outcomes at 3 years of age. Materials and methods: In our single-centre longitudinal cohort study, of the 73 consecutive infants admitted to our Neonatal Intensive Care Unit (NICU), 49 infants (80%) received both Hammersmith Infant Neurological Examination (HINE) at 3- and 6-months corrected age and Bayley–III neurodevelopmental assessment at 2–3 years chronological age. At 3 months follow up, 8.2% had suboptimal scores (below 10th percentile) on the HINE. At 6 months follow up, 4.1% had suboptimal scores (below 10th percentile) on the HINE. The means(±SD) for Bayley-III cognitive, language, and motor subscales were (96.3 ± 9.8), (99.9 ± 11.9), (93.2 ± 9.9). Results: At 3 months corrected age, higher total HINE scores and subscores for function of cranial nerves, posture, tone, were associated with better cognitive scores while poorer scores for function of cranial nerves, posture, movements, tone, and total HINE score were associated with lower motor scores. Infants with a HINE subscore of function of cranial nerves in the suboptimal range have three times higher odds of having a motor delay. Infants with a HINE subscore of function of cranial nerves in the suboptimal range have more than two times higher odds of having a language delay. At 6 months corrected age, poorer scores for function of cranial nerves, movements, tone, reflexes, and total HINE score were associated with worse Bayley-III motor scores whilst infants who have a total HINE score and a subscore of reflexes in the suboptimal range have four and seven times, respectively, higher odds of having a motor delay. Conclusions: Early identification of infants at risk for adverse long-term outcomes is essential in introducing early intervention therapies for optimizing neurodevelopmental outcomes.

Highlights

Over the past two decades, there has been extensive literature on babies with extremely low birth weight (ELBW < 1000 g) and/or extremely preterm (EP < 28 weeks), documenting improved survival mainly due to regionalization of perinatal care, improved technology, and better understanding of their pathophysiology and specific needs [1]
We studied the association of the Hammersmith Infant Neurological Examination (HINE) neurological examination at 3- and 6-months corrected age with Bayley-III in a cohort of EP/ELBW infants at two to three years of chronological age
At 6 months corrected age, poorer scores for function of cranial nerves, movements, tone, reflexes, and total HINE score were associated with lower Bayley III motor scores whilst infants who have a total HINE score and a subscore of reflexes in the suboptimal range have four and more than seven times, respectively, higher odds of having a motor delay

Summary

Introduction

Over the past two decades, there has been extensive literature on babies with extremely low birth weight (ELBW < 1000 g) and/or extremely preterm (EP < 28 weeks), documenting improved survival mainly due to regionalization of perinatal care, improved technology, and better understanding of their pathophysiology and specific needs [1]. Comprehensive examination of ELBW/EP infants should include both neurological and neurodevelopmental assessments for fine-gross motor, cognitive, and language skills and for social-emotional and adaptive behavior functioning, in order to provide the opportunity for enrollment to follow-up program, individualized family training, identification of infants eligible to early intervention services, and yield improved long-term outcomes [9,10]. Infants with a HINE subscore of function of cranial nerves in the suboptimal range have three times higher odds of having a motor delay. At 6 months corrected age, poorer scores for function of cranial nerves, movements, tone, reflexes, and total HINE score were associated with worse Bayley-III motor scores whilst infants who have a total HINE score and a subscore of reflexes in the suboptimal range have four and seven times, respectively, higher odds of having a motor delay. Conclusions: Early identification of infants at risk for adverse long-term outcomes is essential in introducing early intervention therapies for optimizing neurodevelopmental outcomes

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