Neurodevelopmental outcome of preterm very low birth weight infants admitted to an Italian tertiary center over an 11-year period

Stefania Longo,Alessandro Borghesi,Alice Decio,Camilla Pisoni,Carmine Tinelli,Giovanna Tritto,Camilla Caporali,Giada Ariaudo,Roberta La Piana,Cecilia Naboni,Gianfranco Perotti,Arsenio Spinillo,Silvia Spairani,Ivana Olivieri,Barbara Gardella,Davide Tonduti,Simona Orcesi,Federica Manzoni,Mauro Stronati

doi:10.1038/s41598-021-95864-0

Abstract

Preterm very low birth weight infants (VLBWi) are known to be at greater risk of adverse neurodevelopmental outcome. Identifying early factors associated with outcome is essential in order to refer patients for early intervention. Few studies have investigated neurodevelopmental outcome in Italian VLBWi. The aim of our longitudinal study is to describe neurodevelopmental outcome at 24 months of corrected age in an eleven-year cohort of 502 Italian preterm VLBWi and to identify associations with outcome. At 24 months, Griffiths’ Mental Developmental Scales were administered. Neurodevelopmental outcome was classified as: normal, minor sequelae (minor neurological signs, General Quotient between 76 and 87), major sequelae (cerebral palsy; General Quotient ≤ 75; severe sensory impairment). 75.3% showed a normal outcome, 13.9% minor sequelae and 10.8% major sequelae (3.8% cerebral palsy). Male gender, bronchopulmonary dysplasia, abnormal neonatal neurological assessment and severe brain ultrasound abnormalities were independently associated with poor outcome on multivariate ordered logistic regression. Rates of major sequelae are in line with international studies, as is the prevalence of developmental delay over cerebral palsy. Analysis of perinatal complications and the combination of close cUS monitoring and neurological assessment are still essential for early identification of infants with adverse outcome.

Highlights

Preterm very low birth weight infants (VLBWi) are known to be at greater risk of adverse neurodevelopmental outcome
In a previous neurodevelopmental follow-up study in a sample of VLBWi born between 2005 and 2007 evaluated at 24 months of corrected age (CA) using Griffiths Mental Development Scales (GMDS-R), we found that 16% had neurological sequelae (11% minor and 5% major)
Both GA at birth and BW were significantly lower in the deceased group compared with the survivors with six out of eight infants with gestational age < 23 weeks dying in the first hours or within the first 10 days of life, and only two infants surviving to discharge

Summary

Introduction

Preterm very low birth weight infants (VLBWi) are known to be at greater risk of adverse neurodevelopmental outcome. A recent study of a large international cohort of very preterm infants born between 2007 and 2015 in 11 high-income countries showed that in the same period rates of mortality and of major comorbidities decreased in most of them, including Italy[6]. 5–10% of all VLBWi present major motor deficits (cerebral palsy, CP), while 25–50% have cognitive, behavioral and/or attention disabilities. The impact of these deficits and disabilities can be huge, both on the individuals and families concerned, and on public health care resources, especially given the life-long nature of sequelae[7]. The above considerations explain the growing importance of evaluating short- and long-term developmental outcome in premature infants admitted to neonatal intensive care units (NICUs)

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