Neurological follow-up of very low birthweight premature infants and very preterm infants

Abstract

Objective To investigate the neurodevelopment of very low birth weight (VLBWI) and very preterm infants(VPI) and the factors influencing that development, especially the effect of early intervention. Methods Early intervention and follow-up visits were performed on 114 VPIs and VLBWIs after their discharge from the neonatal NICU. The infants were classified into an intervention group and a non-intervention group, based on whether the parents had performed early family intervention or not. The infants received the infant Developmental test of Children's Center of China (CDCC) at 1 year old. According to the test results, they were divided into a normal mental development index (MDI) group, an abnormal MDI group, a normal psychomotor development index (PDI) group and an abnormal PDI group. A 20-item neurological movement scale was also used to assess the subjects. Potential high-risk factors were sought using Logistic regression. Results Significant differences between the normal and abnormal MDI groups were observed in terms of the male/female ratio, the incidence of asphyxia and hypothermia, antenatal training and the intensity of their early education (P<0.05). There were also significant differences between the normal and abnormal PDI groups in terms of gestational age and the incidence of asphyxia, hypoxic-ischemic encephalopathy and intracranial hemorrhage (P<0.05). The fathers' education level, antenatal training and the frequency of intervention also predicted PDI scores. The average PDI and MDI score of the intervention group was 97.40±21.07 and 96.15±18.10, and those of the non-intervention group were 81.70±21.69 and 91.35±19.24, both with significant difference between the two groups (P<0.05). In the intervention group significantly fewer infants had abnormal PDI scores, with abnormal results of the 20-item scale or cerebral palsy (P<0.05). The regression results suggest that asphyxia and hypoxic-ischemic encephalopathy are risk factors for poor mental and psychomotor development, but parents' attaching importance to their children's early education and active intervention can promote the mental and psychomotor development. Conclusion Premature infants with a birth weight less than 1500 g and a gestation age less than 32 weeks have a high incidence of abnormal neurological development. Neurodevelopment can be improved by reducing the incidence of asphyxia, putting emphasis on children's early education and giving active intervention. Key words: Early intervention; Cerebral palsy; Birth weight; Preterm infants; Premature infants; Outcomes