Follow-up Of Preterm Infants Research Articles

Impact of COVID-19 pandemic on neurodevelopmental outcomes of premature infants: a retrospective national cohort study

ObjectiveTo compare the neurodevelopmental outcomes of preterm infants before and during the COVID-19 pandemic.DesignPremature infants born in 2018 were assigned to the pre-pandemic group, while those born in 2019 were...

Developing a practical neurodevelopmental prediction model for targeting high-risk very preterm infants during visit after NICU: a retrospective national longitudinal cohort study

BackgroundFollow-up visits for very preterm infants (VPI) after hospital discharge is crucial for their neurodevelopmental trajectories, but ensuring their attendance before 12 months corrected age (CA) remains a challenge. Current prediction models focus on future outcomes at discharge, but post-discharge data may enhance predictions of neurodevelopmental trajectories due to brain plasticity. Few studies in this field have utilized machine learning models to achieve this potential benefit with transparency, explainability, and transportability.MethodsWe developed four prediction models for cognitive or motor function at 24 months CA separately at each follow-up visits, two for the 6-month and two for the 12-month CA visits, using hospitalized and follow-up data of VPI from the Taiwan Premature Infant Follow-up Network from 2010 to 2017. Regression models were employed at 6 months CA, defined as a decline in The Bayley Scales of Infant Development 3rd edition (BSIDIII) composite score > 1 SD between 6- and 24-month CA. The delay models were developed at 12 months CA, defined as a BSIDIII composite score < 85 at 24 months CA. We used an evolutionary-derived machine learning method (EL-NDI) to develop models and compared them to those built by lasso regression, random forest, and support vector machine.ResultsOne thousand two hundred forty-four VPI were in the developmental set and the two validation cohorts had 763 and 1347 VPI, respectively. EL-NDI used only 4–10 variables, while the others required 29 or more variables to achieve similar performance. For models at 6 months CA, the area under the receiver operating curve (AUC) of EL-NDI were 0.76–0.81(95% CI, 0.73–0.83) for cognitive regress with 4 variables and 0.79–0.83 (95% CI, 0.76–0.86) for motor regress with 4 variables. For models at 12 months CA, the AUC of EL-NDI were 0.75–0.78 (95% CI, 0.72–0.82) for cognitive delay with 10 variables and 0.73–0.82 (95% CI, 0.72–0.85) for motor delay with 4 variables.ConclusionsOur EL-NDI demonstrated good performance using simpler, transparent, explainable models for clinical purpose. Implementing these models for VPI during follow-up visits may facilitate more informed discussions between parents and physicians and identify high-risk infants more effectively for early intervention.

Web-based follow-up tool (ePIPARI) of preterm infants—study protocol for feasibility and performance

BackgroundPreterm infants have a risk of health and developmental problems emerging after discharge. This indicates the need for a comprehensive follow-up to enable early identification of these problems. In this paper, we introduce a follow-up tool “ePIPARI – web-based follow-up for preterm infants”. Our future aim is to investigate whether ePIPARI is a feasible tool in the follow-up of preterm infants and whether it can identify children and parents in need of clinical interventions.MethodsePIPARI includes eight assessment points (at term age and at 1, 2, 4, 8, 12, 18, and 24 months of corrected age) when the child´s health and growth, eating and feeding, neurodevelopment, and parental well-being are evaluated. ePIPARI consists of several widely used, standardized questionnaires, in addition to questions typically presented to parents in clinical follow-up visits. It also provides video guidance and written information about age-appropriate neurodevelopment for the parents.Parents of children born before 34 weeks of gestation during years 2019–2022 are being invited to participate in the ePIPARI study, in which web-based follow-up with ePIPARI is compared to clinical follow-up. In addition, the parents of children born before 32 weeks of gestation, who reached the corrected age of two years during 2019–2021 were invited to participate for the assessment point of 24 months of ePIPARI. The parents are asked to fill in the online questionnaires two weeks prior to each clinical follow-up visit.DiscussionThe web-based tool, ePIPARI, was developed to acquire a sensitive and specific tool to detect infants and parents in need of further support and clinical interventions. This tool could allow individualized adjustments of the frequency and content of the clinical visits.Trial registrationClinicalTrials.cov, NCT05238168. Registered 11 April 2022 – Retrospectively registered.

Clinical outcomes of different patent ductus arteriosus treatment in preterm infants born between 28 and 32 weeks in Taiwan.

The patent ductus arteriosus (PDA) treatment in very preterm infants is controversial. This study focused on preterm infants born at 28-32 weeks of gestation and analyzed the association between various PDA treatments and clinical outcomes. We conducted a retrospective cohort study of infants born at 28-32 weeks of gestation between 2016 and 2019at 22 hospitals in the Taiwan Premature Infant Follow-up Network. We categorized the infants into four groups according to treatment strategies: medication, primary surgery, medication plus surgery, or conservative treatment. A total of 1244 infants presented with PDA, and 761 (61.1%) were treated. Medication was the predominant treatment (50.0%), followed by conservative treatment (38.9%), medication plus surgery (7.6%), and primary surgery (3.5%). The risk of mortality was not reduced in the active treatment group compared to the conservative treatment group. There was a higher prevalence of severe intraventricular hemorrhage, necrotizing enterocolitis (NEC), and any degree of bronchopulmonary dysplasia (BPD) in both the primary surgery and medication plus surgery groups than in the conservative treatment group. After adjustment, both the primary surgery and medication plus surgery groups still had higher odds ratios for the occurrence of NEC and any degree of BPD. Compared with active PDA treatment, conservative treatment for PDA did not increase the risk of mortality and morbidity in very preterm infants born at 28-32 weeks of gestation. The risks and benefits of surgery (PDA ligation) in these infants must be considered cautiously.

Association of mode of delivery with short-term and neurodevelopmental outcomes in periviable singleton infants: A nationwide database study.

To evaluate the association of mode of delivery (MOD) with short-term and neurodevelopmental outcomes at 2 years of corrected age (CA) in periviable singleton infants. This retrospective cohort study of the Taiwan Premature Infant Follow-up Network database between 2010 and 2016 compared non-anomalous singleton deliveries (cesarean delivery [CD] vs vaginal delivery [VD]) between 22 0/7 and 25 6/7 gestational weeks. Major morbidities, mortality, and neurodevelopmental outcomes were evaluated at 2-year CA. The CD and VD groups included 354 and 472 infants, respectively. The intraventricular hemorrhage (IVH) rate was lower in the CD group (54% vs 66%, P = 0.001), but severe IVH differed non-significantly between groups (20% vs 26%, P = 0.057). In the small-for-gestational age subgroup, CD was associated with lower IVH (56% vs 84%, adjusted odds ratio [aOR] 0.17, 95% confidence interval [CI] 0.04-0.69) and better survival without neurodevelopmental impairment (29% vs 8%, aOR, 6.64, 95% CI 1.02-43.29) after controlling for potential confounders. The optimal MOD for periviable singleton birth and its impact are unclear. CD in periviable singleton births is associated with a decreased IVH risk, without improvement in severe IVH, mortality, or neurodevelopment at 2-year CA. The small-for-gestational age subgroup may benefit from CD for better survival without neurodevelopmental impairment.

Classification Performance of the Ages and Stages Questionnaire: Influence of Maternal Education Level

(1) Background: The Ages and Stages Questionnaire-Third Edition (ASQ-3) is a parental screening questionnaire increasingly being used to evaluate the development of preterm children. We aimed to assess the classification performance of the ASQ-3 in preterm infant follow-up. (2) Methods: In this cross-sectional study, we included 185 children from the SEVE longitudinal cohort born <33 weeks of gestational age between November 2011 and January 2018, who had both an ASQ-3 score at 24 months of corrected age (CA) and a revised Brunet-Lézine (RBL) scale score at 30 months of CA. The ASQ-3 overall score and sub-scores were compared to the RBL developmental quotient (DQ) scores domain by domain. The diagnostic performance of the ASQ-3 was evaluated with the RBL as the reference method by calculating sensitivity, specificity, and positive and negative likelihood ratios. A multivariate analysis assessed the association between low maternal education level and incorrect evaluation with the ASQ-3. (3) Results: The ASQ-3 overall score had a specificity of 91%, a sensitivity of 34%, a positive likelihood ratio of 3.82, and a negative likelihood ratio of 0.72. Low maternal education level was a major risk factor for incorrectly evaluating children with the ASQ-3 (odds ratio 4.16, 95% confidence interval 1.47-12.03; p < 0.01). (4) Conclusions: Regarding the low sensitivity and the impact of a low maternal education level on the classification performance of the ASQ-3, this parental questionnaire should not be used alone to follow the development of preterm children.

Premature Infants have no Higher Risk of Atopy and Respiratory Functions Compared to Control at 4-6 Years of Age.

This study aimed to evaluate the respiratory functions and atopy conditions of preterm infants treated with aminophylline or caffeine for apnea in NICU in early childhood. This is a retrospective cohort study. In this study, 27 patients aged 4 to 6 years hospitalized in NICU for prematurity and 26 healthy children were included. The subjects were evaluated for fx5, phadiatope, total IgE levels, skin tests, and respiratory function tests. There was no statistically significant difference among groups in terms of fx5, phadiatope, total IgE levels, and skin test results. Moreover, no statistically significant difference was found among the groups in terms of FVC, FEV1, FEV1/ FVC, PEF, MEF75, MEF50, MEF25, and MEF25-75 values in respiratory function tests. Preterm neonates with bronchopulmonary dysplasia (BPD) had higher FEV1 values compared to ones without BPD (p=0.02). Preterm infants treated with aminophylline or caffeine did not have a higher risk of atopy and had similar respiratory function tests compared to healthy infants at 4-6 years old. However, FEV1 values were higher in infants with BPD. These results suggested that respiratory functions could be affected in the long-term follow-up of premature infants with BPD.

Prevention care and follow-up of premature infants - Point of view from paediatric nephrologist

OBJECTIVE: Review renal and cardiovascular complications derived from premature births, to warn the pediatrician about preventive care and to recommend an approach toward the follow-up. METODOLOGY: non-systematic review of literature which based its data on: National Library of Medicine, US National Library of Medicine, Latin American and Caribbean Literature on Health Sciences and Scientific Electronic Library Online, ranging from 2010 to 2021. The articles were delved into the issues of prematurity, low birth weight, restricted intrauterine growth and its relation with cardiovascular and renal diseases; and proposed follow-up strategies. RESULTS: The incidence of premature births has increased in the last few decades, with a variation between 5% to 14%, and, consequently, the rate of chronic-related diseases related to this situation has increased as well. The number of incomplete and immature nephrons in premature babies derives from the lack of completeness of nephrogenesis, which takes place at around 36 weeks of pregnancy. This nephron deficit necessitates a hemodynamic adaptation to meet the demands of urinary excretion. This process may be responsible for glomerular hypertension, the hypertrophy of remaining nephrons and resulting renal injuries. Factors such as low birth weight, restricted intrauterine growth and premature birth all contribute towards the global increase of the prevalence of renal disease, systemic arterial hypertension and metabolic syndrome. CONCLUSION: Children born premature, with low birth weight and restricted intrauterine growth must have their arterial pressure and kidney functions monitored throughout the paediatric follow-up, and sent to a paediatric nephrologist whenever any abnormalities are detected.

Uso do grupo de WhatsApp® no acompanhamento pós-alta do bebê prematuro: implicações para o cuidado em enfermagem

Abstract Objective to analyze the use of the WhatsApp® application, as a technological tool, to help mothers in the post-discharge follow-up of their premature infant. Method a qualitative study conducted with 18 mothers of preterm infants who had been admitted to the neonatal units of a university hospital in the interior of São Paulo. Data were collected from July to November 2021 through messages left in a WhatsApp® group for the post-discharge follow-up of preterm infants. The messages were analyzed using Thematic Content Analysis. Results the WhatsApp® group had good acceptance and adhesion by the mothers, who were able to share their experiences, knowledge, and feelings. The main topics raised were: Breastfeeding the premature baby; Management of infant colic; Basic care of the premature baby at home; Experiences in the hospitalization of the premature baby; Challenges faced at home; Mothers' perception of the WhatsApp® group. Conclusion and implications for the practice the mothers showed insecurities and doubts about the basic care of the premature baby at home. The strategy of using the WhatsApp® application in the health monitoring of premature babies showed satisfactory results, favoring the continuity of care and support to mothers.

Organizational models of ophthalmic observation of premature children in pediatric follow-up

Purpose: to assess the organizational effectiveness of ophthalmic observation of premature infants in pediatric follow-up in St. Petersburg. Material and methods. We analyzed the reports submitted by city interdistrict ophthalmological facilities for retinopathy of prematurity (ROP) and the observation department for premature infants for the period from July 1, 2018 to July 1, 2021 available at the children's multidisciplinary hospital. Results. In St. Petersburg, 6 interdistrict ophthalmological facilities perform regular monitoring of ROP children and a daytime in-patient clinic offers interdisciplinary treatment and early rehabilitation of infants with perinatal pathology accompanying severe prematurity. The data on the frequency of ROP and other visual disorders in children born prematurely are presented. Conclusions. Interdistrict observation facilities are a modern form of regular ophthalmic follow-up of premature infants of risk groups or ROP infants who live in conditions of a large city. A promising observation model of children with combined perinatal pathology and severe prematurity is the setting of a department (daytime in-patient facility) in the children's multidisciplinary hospital. This allows assessing the general health of this critical group of population" and ensure a timely start of combined interdisciplinary treatment and medical rehabilitation.

Neurodevelopmental Outcomes for Retinopathy of Prematurity: A Taiwan Premature Infant Follow-up Network Database Study

To evaluate the neurodevelopmental outcomes in premature infants who received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections to treat retinopathy of prematurity (ROP). Retrospective cohort study. This study was conducted using the database from the Taiwan Premature Infant Follow-up Network. Demographic data, systemic risk factors, ROP status, and neurodevelopmental assessment using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) were collected. Patients were divided into 4 groups: prematurity without ROP, ROP without treatment, ROP with laser treatment, and ROP with intravitreal anti-VEGF treatment. A generalized estimating equation was used for analyzing repeated measurements of Bayley-III at the corrected ages of 6, 12, and 24 months. A total of 2090 patients with a mean gestational age of 31.2 weeks were included. The Bayley-III composite scores of patients with ROP treated with anti-VEGF were comparable to those of patients with ROP without treatment (cognitive: P=.491; language: P=.201; motor: P=.151) and premature patients without ROP (cognitive: P=.985; language: P=.452; motor: P=.169) after adjusting for confounders. Patients with ROP treated with laser photocoagulation exhibited poorer cognitive composite scores than did those without treatment (P < .001), premature patients without ROP (P < .001), and those treated with anti-VEGF (P < .001), but they had similar language and motor composite scores. Intravitreal anti-VEGF treatment for ROP was not associated with adverse neurodevelopment in premature infants. Further studies are needed to determine whether general anesthesia or sedation used in laser treatment for ROP has significant impacts on neurodevelopmental outcomes.

The effect of feeding methods of bottle and injector on the transition to full breastfeeding and sucking success in preterm newborns: A randomized controlled trial

PurposeThis study was conducted to investigate the effects of feeding methods of bottle and injector on the transition to full breastfeeding and sucking success in preterm newborns. Design and methodsThis study was a randomized controlled type experimental study. The study sample included 62 preterm newborns, resulting from the strength analysis, who were treated in the neonatal intensive care unit of a university hospital (31 bottle-feeding group, 31 injector feeding group). Data were collected using the Descriptive Information Form, Preterm Infant Follow-up Form and LATCH Breastfeeding Diagnostic Scale. The infants in the syringe and the bottle-feeding group were fed, and the sucking successes and transition times to breastfeeding were evaluated during the first breastfeeding, after 48 h and before discharge. ResultsWhen sucking successes and transition times to breastfeeding were evaluated, LATCH scores of the mothers in the syringe feeding group were significantly higher than the mothers in the bottle-feeding group, and infants switched to full breastfeeding in a shorter time (p < 0.05). When the physical parameter results were evaluated, the mean heart rate of the babies in the bottlefed group was significantly higher than the injector-fed group (p < 0.05). ConclusionsIt has been seen that injecting feeding method has a positive effect on the success of the newborn, the time of transition to full breastfeeding and life signs according to the bottle-feeding method. The findings obtained in this study suggest that to increase the success of sucking, shortening the transition time to full breastfeeding and using the injector feding method to maintain stabile physical parameters. Application to practiceThe findings obtained in this study suggest that to increase the success of sucking, shortening the transition time to full breastfeeding and using the injector feding method to maintain stabile physical parameters.

Quality of follow-up of preterm infants in the Primary Health Care network: "Qualipreterm" guide.

to develop the first version of an assessment guide for the quality of follow-up of preterm infants in Primary Health Care. a descriptive methodological study, which developed a guide to assess follow-up quality of preterm infants in Primary Care. Steps of conceptual establishment, construction of items and answers, organization of domains and structuring of the guide were carried out. the guide was organized in five domains that included: Hospital discharge planning and care plan organization; Home follow-up during visits and teleservice; Infant health monitoring to promote health and prevent injuries; Integration between health services, education and specialized monitoring; Family support and support for care. It is proposed to assess the domains in inadequate, regular, good and excellent. the first version of the guide suggests assessment elements aimed at the recommendations of good practices for preterm infants' health in the Primary Health Care network.

Quality of follow-up of preterm infants in the Primary Health Care network: “Qualipreterm” guide

RESUMO Objetivos: desenvolver a primeira versão de um guia avaliativo da qualidade do seguimento do bebê prematuro na Atenção Primária à Saúde. Métodos: estudo descritivo metodológico, que desenvolveu um guia para avaliar a qualidade do seguimento do bebê prematuro na Atenção Primária. Realizadas etapas de estabelecimento conceitual, construção dos itens e respostas, organização de domínios e estruturação do guia. Resultados: o guia foi organizado em cinco domínios que contemplou: Planejamento da alta hospitalar e organização do plano de cuidados; Seguimento domiciliar em visita e teleatendimento; Seguimento da saúde infantil para promover saúde e prevenir agravos; Integração entre serviços de saúde, educação e acompanhamento especializado; Apoio e suporte familiar para o cuidado. Propõe-se avaliar os domínios em inadequado, regular, bom e excelente. Considerações Finais: a primeira versão do guia sugere elementos de avaliação direcionados às recomendações de boas práticas para a saúde do prematuro na rede de Atenção Primária à Saúde.

Assessment of growth pattern of preterm infants up to a corrected age of 24 months.

To assess the growth of preterm infants up to a corrected age of 24 months, and to understand the growth trend and pattern of preterm infants. A preterm infant follow-up database was established based on the Internet Plus follow-up system. A total of 3 188 preterm infants who were born from April 2018 to April 2021 were enrolled. Their length, weight, and head circumference were recorded at birth and at the corrected ages of 1, 3, 6, 12, 18, and 24 months. The preterm infants were grouped by perinatal factors. The growth curves of these infants were plotted and compared with the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) standard and World Health Organization (WHO) standard. The weight, length, and head circumference curves of each group of preterm infants grouped by various perinatal factors all rose rapidly within the corrected age of 6 months, but the growth rate slowed down after the corrected age of 6 months. Based on the actual age for the groups of preterm infants with different gestational ages (<28 weeks, 28-31+6 weeks, 32-33+6 weeks, and 34-36+6 weeks), the length curve gradually coincided with the WHO curve after the actual age of 9 months (P=0.082), while for the preterm infants with a gestational age of <32 weeks, the weight and head circumference curves were significantly lower than the WHO curves (P<0.001). Based on the corrected age, the physical growth curve of preterm infants with different gestational ages (<28 weeks, 28-31+6 weeks, 32-33+6 weeks, and 34-36+6 weeks) basically coincided with each other (P>0.05). For the infants with extremely low birth weight and the small-for-gestational-age infants, the length, weight, and head circumference curves were significantly lower than those of the INTERGROWTH-21st standard and the WHO standard (P<0.05). The physical growth rate of preterm infants is faster within the corrected age of 6 months, and the growth rate slows down after the corrected age of 6 months. Preterm infants with a smaller gestational age need longer time to catch up in weight and head circumference. More attention should be paid to the physical growth of extremely preterm infants, extremely low birth weight infants, and small-for-gestational-age infants.

Early Life Factors Associated with Preschool Wheezing in Preterm Infants.

Advanced neonatal care has increased the survival of neonates born prematurely, and prematurity is a well-known risk factor for asthma/wheezing disorders. Thus, this prospective study aimed to determine the early life factors associated with preschool wheezing in premature neonates. Preterm neonates born between 2012 and 2017 were recruited, excluding those with bacterial infection within 7 days of life, maternal sepsis, and maternal chorioamnionitis. Birth and admission history, comorbidities, and maternal history were documented. Respiratory problems were followed-up at the neonatal outpatient department. Patients were divided into wheezing and non-wheezing groups. Data were analyzed using the Mann–Whitney test and Fisher’s exact test, and multivariable logistic regression was used to define the risk factors of preschool wheezing/asthma. A total of 125 preterm infants were enrolled, including 19 in the wheezing group and 106 in the non-wheezing group. Patients in the wheezing group had longer duration of intubation (p = 0.025), higher rates for exclusive breast milk feeding (p = 0.012), and higher re-hospitalization rates for respiratory tract infections (p < 0.001), especially for respiratory syncytial virus (RSV) bronchiolitis (p = 0.045). The incidence of allergic rhinitis was also higher in the wheezing group (p = 0.005). After multivariable logistic regression, allergic rhinitis and re-hospitalization for respiratory tract infections were two significant risk factors for preschool wheezing/asthma in premature neonates. Close follow-up of premature infants at high risk for asthma susceptibility is recommended.

Long-term Follow-up of Preterm Infants Having Been Colonized With Extended Spectrum Beta-lactamase-producing Enterobacterales Over the First 6 Years of Life.

We performed a retrospective case-control cohort study following 146 preterm infants (≤32 weeks of gestation) who had been colonized with extended spectrum beta-lactamase producing Enterobacterales and compared them with 1:1 matched controls regarding rates of hospitalizations and outpatient visits because of infectious and gastrointestinal diseases and developmental impairment up to school age. Preterm infants with extended spectrum beta-lactamase producing Enterobacterales colonization did have neither higher rates of gastrointestinal or infectious diseases nor higher rates of developmental impairments up to the age of 6 years.

Long-term follow-up of premature infants with urinary tract infection

Urinary tract infection (UTI) is common in preterm infants and may have long-term sequela, such as recurrent infections and renal scarring in older children. We assessed long-term outcomes of preterm infants with UTI, born during 1996-2008 in Schneider Children's Medical Center's neonatal intensive care unit (NICU), and incidence of UTI recurrence. Of 89 preterm infants, seven were excluded due to prenatal diagnosis of congenital anomalies of the kidney and urinary tract (CAKUT), 41 interviewed by phone, 18 presented for follow-up evaluation in the nephrology clinic, and 23 lost to follow-up. No patient who completed follow-up reported additional UTI episodes or issues related to kidney and urinary tract. Clinically evaluated participants were 17.1 ± 3.6 years, born prematurely at 29.4 ± 4 weeks. All had a normal estimated glomerular filtration rate of >90 ml/min/1.73m2; four (22%) had systolic blood pressure >90th percentile; none had proteinuria (mean protein/creatinine ratio 0.09 ± 0.04 mg/mg) or albuminuria (mean albumin/creatinine ratio 10.2 ± 6.3 mcg/mg). Renal ultrasonography done in the first years of life in 12 (66%) patients demonstrated normal kidney size and structure.Conclusion: In this pilot study, a single episode of UTI in premature infants without CAKUT did not constitute a risk factor for recurrence of infections or kidney injury in their first two decades of life. Thus, normal ultrasound in NICU excluding CAKUT may be sufficient for premature patients with UTI, with no need of further imaging or long-term nephrology follow-up. What is Known: • Urinary tract infection (UTI) is one of the most common bacterial infections in neonates and premature infants. Risk factors for UTI recurrence in children are congenital anomalies of the kidney and urinary tract (CAKUT) and bladder and bowel dysfunction. • The recurrence rate and long-term renal sequela of UTI in preterm infants have not been studied. Guidelines regarding management and long-term follow-up for infants less than 2 months old are lacking. What is New: • A single episode of UTI in premature infants without CAKUT probably does not constitute a risk factor for UTI recurrence, and it is unlikely to cause renal injury in the first two decades of life. • For premature infants with UTI without sonographic diagnosis of CAKUT in NICU, prophylactic antibiotic treatment, further imaging, or long-term nephrology follow-up may be unnecessary.

Predictive Validity of the Bayley-III Cognitive Scores at 6 Months for Cognitive Outcomes at 24 Months in Very-Low-Birth-Weight Infants.

Purpose: To assess the predictive validity of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) cognitive scores at 6 months of corrected age (CA) for cognitive outcomes at 24 months of CA in very-low-birth-weight (VLBW) infants and investigate the predictors of change in cognitive outcomes.Methods: We retrospectively evaluated VLBW children enrolled in the Taiwan Premature Infant Follow-up Network between 2010 and 2015 and completed the Bayley-III at CA of 6 and 24 months. The predictive validity of the cognitive performance at 6-month CA for the cognitive outcomes at 24-month CA was analyzed. The positive and negative predictive factors were also evaluated using logistic regression. Cut-off scores of <70 and <85 were used to identify lower functioning groups based on the Bayley-III definition.Results: A total of 2,972 VLBW children, born with a mean weight of 1116.4 ± 257.5 g and mean gestational age of 29.0 ± 2.8 weeks, were evaluated. A cognitive score of <70 at 6-month CA had a positive predictive value (PPV) of 27.4% (95% confidence interval [CI]: 19.2–35.7%) for a cognitive score of <70 at 24-month CA, while the negative predictive value (NPV) was 97.3% (95% CI: 96.7–97.9%). A cut-off score of 85 had a PPV of 33.6% (95% CI: 28.1–39.0%) and an NPV of 87.7% (95% CI: 86.4–88.9%). Abnormal muscle tone at 6 months was a risk factor for cognitive function decline at 24 months for both Bayley-III cognitive cut-off scores: scores of 70 (adjusted odds ratio [AOR]: 2.8; 95% CI: 1.5–5.5) and 85 (AOR: 2.6; 95% CI: 1.6–4.1). Lower maternal socioeconomic status was associated with a worsening of the cognitive function in infants at 24 months who scored ≥85 at 6 months (AOR: 1.6; 95% CI: 1.2–2.0).Conclusion: Subnormal Bayley-III cognitive scores at 6-month CA were not predictive of subnormal cognitive function at 24-month CA. In children with normal cognition during early infancy, abnormal muscle tone and lower maternal socioeconomic status may influence the cognitive developing process; this highlighted the importance of early identification of high risk infants and complete preterm infant-associated public health policies to promote an improved neurodevelopmental outcome.

Risk-adjusted rates between hospitals for adverse outcomes of very-low-birth-weight infants

To analyze the amount of variation in these risk-adjusted adverse outcomes corresponding to the care of premature births. In addition, hospitals were ranked according to their unadjusted and adjusted rates, and we assessed the degree of concordance between these rankings. Finally, the correlations of hospital-adjusted adverse outcomes were also tested. The study utilized the 5-year Taiwan Premature Infant Follow-up Network (TPFN) database in Taiwan from 2014 to 2018, and the sample size was 6482. We calculated the "observed over expected" (OE) ratio every year to form the risk-adjusted adverse outcome rate for each hospital. There was a larger variation in the risk-adjusted rate for NEC and the second-largest variation for IVH. Regarding the concordances between the unadjusted and adjusted ranks, the ranks for mortality had the lowest concordance (coefficient of concordance 0.64), and only a few of the risk-adjusted rates between outcomes were significantly correlated. The results of the TPFN show that there is room to improve performance in terms of large variations in NEC and IVH. Furthermore, risk adjustment is important, especially for mortality, since the ranks for mortality have the lowest concordance. Finally, we cannot generate a conclusion regarding whether a hospital is high in quality if we only take 1 or 2 adverse outcomes as profiling measures because only a few of the risk-adjusted rates between outcomes were significantly correlated.