Abstract
Objective: The purpose of this study was to investigate perinatal factors associated with a poor neurodevelopmental outcome in preterm infants.Methods: A retrospective study was conducted by searching our clinical database between January 2006 and December 2016. A total of 165 singleton children who were born between 23 and 33 weeks of gestation were included. We defined poor neurological development outcomes as follows: cerebral palsy; intellectual disability; developmental disorder including autism and attention-deficit/hyperactivity disorder; low score (<85 points) on Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III); or low score of Kyoto Scale of Psychological Development corrected at 3 years old. We diagnosed maternal renal dysfunction according to the Clinical Practice Guideline for chronic kidney disease 2018 and the Best Practice Guide 2015 for Care and Treatment of Hypertension in Pregnancy.Results: The rate of poor neurological development was 25/165 (15.2%): cerebral palsy (n = 1), intellectual disability (n = 1), developmental disorder (n = 2), low score of Bayley-III (n = 20), and low score of Kyoto Scale of Psychological Development (n = 1). Preeclampsia complicated with maternal renal dysfunction (P = 0.045) and delivery at <30 weeks of gestation (P = 0.007) were independent risk factors for poor neurological development.Conclusions: In addition to previous risk factors such as delivery at <30 weeks of gestation, preeclampsia complicated with renal dysfunction was also associated with poor neurodevelopmental outcomes corrected at 3 years old.
Highlights
We excluded cases with children born to mothers with abruptio placenta (n = 4), with congenital malformation (n = 15), intrauterine fetal death (IUFD) (n = 15), who died as neonates (n = 7), those transferred to another hospital (n = 36), and cases of sudden infant death syndrome (SIDS) (n = 1)
Poor neurological development was noted in 25 cases (15.2%) of 165 infants as follows: cerebral palsy (n = 1), intellectual disability (n = 1), developmental disorder including autism and attention-deficit/hyperactivity disorder (ADHD) (n = 2), low score (
No significant differences were observed between the good outcome group and the poor outcome group in clinical characteristics including prepregnancy body mass index (BMI) (20.4 vs. 19.9, respectively, P = 0.487), predelivery BMI (22.8 vs. 22.3, respectively; P = 0.505), gestational weight gain (5.2 vs. 4.8, respectively; P = 0.883), rates of gestational diabetes mellitus (%) (2.1 vs. 4.0, respectively; P = 0.578), hypothyroidism (%)
Summary
Poor neurological development of preterm infants is related to delivery weeks [1, 2], fetal growth restriction [3, 4], chorioamnionitis, maternal infection [5], maternal increased body mass index (BMI) [6], socioeconomic disadvantage [7, 8], not receiving breast milk at discharge [7], neonatal intensive care unit (NICU) noise [9], longer intensive care unit stay, more complex forms of congenital heart disease [8], and maternal preeclampsia (PE) [10, 11].Children born to mothers with PE show developmental disorders [10, 11] that contain cognitive, behavioral, and mood deficits compared with offspring from mothers with noncomplicated pregnancies [12]. Severe PE is a disease complicated with hypertension and proteinuria with or without kidney and liver damage, oliguria, PE, cerebral edema, and cerebral hemorrhage. This will lead to perinatal and neonatal problems, including preterm birth, fetal growth restriction (FGR), reduced birth weight, and NICU stays. Barker [13] demonstrated that many human fetuses have to adapt to a limited supply of nutrients, and so they change their metabolism and physiology These changes may be the origins of many diseases in later life, including diabetes, hypertension, and coronary heart disease [13]
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