Abstract
To date, the difference in neurodevelopmental outcomes between late preterm infants (LPI) born at 34 and 35 gestational weeks (LPI-34 and LPI-35, respectively) has not been elucidated. This retrospective study aimed to evaluate neurodevelopmental outcomes at 18 months of corrected age for LPI-34 and LPI-35, and to elucidate factors predicting neurodevelopmental impairment (NDI). Records of all LPI-34 (n = 93) and LPI-35 (n = 121) admitted to our facility from 2013 to 2017 were reviewed. Patients with congenital or chromosomal anomalies, severe neonatal asphyxia, and without developmental quotient (DQ) data were excluded. Psychomotor development was assessed as a DQ using the Kyoto Scale of Psychological Development at 18 months of corrected age. NDI was defined as DQ < 80 or when severe neurodevelopmental problems made neurodevelopmental assessment impossible. We compared the clinical characteristics and DQ values between LPI-34 (n = 62) and LPI-35 (n = 73). To elucidate the factors predicting NDI at 18 months of corrected age, we compared clinical factors between the NDI (n = 17) and non-NDI (n = 118) groups. No significant difference was observed in DQ values at 18 months of corrected age between the groups in each area and overall. Among clinical factors, male sex, intraventricular hemorrhage (IVH), hyperbilirubinemia, and severe hyperbilirubinemia had a higher prevalence in the NDI group than in the non-NDI group, and IVH and/or severe hyperbilirubinemia showed the highest Youden Index values for predicting NDI. Based on the results of this study, we can conclude that no significant difference in neurodevelopmental outcomes at 18 months of corrected age was observed between LPI-34 and LPI-35. Patients with severe hyperbilirubinemia and/or IVH should be considered to be at high risk for developing NDI.
Highlights
Despite the decrease in birth rate in recent years, the birth rate of late preterm infants (LPI) born between 34 0/7 and 36 6/7 gestational weeks (GW) is increasing [1,2]
We have routinely evaluated LPI born at 34 and 35 GW (LPI-34 and LPI-35, respectively) for their developmental quotient (DQ) at around 18 months of corrected age
If the prevalence of neurodevelopmental impairment (NDI) was calculated to differ by 20% between the LPI-34 and LPI-35 groups, this would result in an 80% chance of detecting this difference with a type I risk error of 5% with 56 infants in each group
Summary
Despite the decrease in birth rate in recent years, the birth rate of late preterm infants (LPI) born between 34 0/7 and 36 6/7 gestational weeks (GW) is increasing [1,2]. Observed that LPI had significantly higher risks of developing cerebral palsy and developmental delay/ intellectual disability than those born at term [6]. Concerning adulthood outcomes, Moster et al reported that LPI had an increased risk for neurodevelopmental problems, including cerebral palsy, intellectual disability, and disorders of psychological development, behavior, and emotion [8]. We recalled the concept that routine evaluation of the psychomotor development of uncomplicated LPI could be limited only to those at high risk for NDI, such as infants born at 34 GW. To date, many studies that examined long-term outcomes have categorized preterm infants born at 34–36 GW into the same LPI group, and even fewer studies have examined the prognosis of LPI according to gestational age. This study aimed to clarify the difference in neurodevelopmental outcomes at 18 months of corrected age between LPI born at 34 and 35 GW
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