Prediction of Neurodevelopmental Outcome of Preterm Babies Using Risk Stratification Score.

Abstract

To study the incidence of major neurodevelopmental disability (NDD) at 1y age (corrected for prematurity) in a cohort of preterm Indian babies (≤33wk) and to predict NDD based on perinatal risk factors. This prospective cohort study was conducted at a referral neonatal intensive care unit (NICU) with a developmental follow up clinic in private sector in Kerala, India. The study was conducted for 4.5 y - January 2005 to July 2009. All preterm babies ≤33wk at birth, discharged from the NICU were included. Pre-defined perinatal and neonatal risk factors known to affect neurodevelopmental outcome were recorded prospectively, in a structured form. Babies were followed to 1y of age, corrected for prematurity and classified as normal or as having major neurodevelopmental disability (NDD). Major NDD was defined as cerebral palsy or Development Assessment Scale for Indian Infants (DASII) motor /mental score <70 or blindness in one or both eyes or hearing impairment needing hearing aids. The incidence of major NDD at 1y age (corrected for prematurity) among the 225 preterm babies was 6.2%. A clinical score was devised by combining 5 risk factors, gestation ≤28wk, need for extensive resuscitation at birth, symptomatic hypoglycemia, invasive ventilation for >7d and abnormal neurosonogram. Scores of 1 to 5 were associated with 4, 6, 10, 25, 100% risk of major NDD respectively (p < 0.01). The authors could stratify 87.5% of the babies into low risk (score of 1 or 2) for NDD and 12.5% into high risk (score 3 or 4 or 5) for major NDD. Majority of the preterm babies at lower risk of NDD need less intensive follow up, while those at higher risk (12.5%) should be guided to more frequent structured follow up and early intervention program.