Rates Of Neurodevelopmental Impairment Research Articles

No change in neurodevelopment at 11 years after extremely preterm birth

ObjectiveTo determine whether improvements in school age outcomes had occurred between two cohorts of births at 22–25 weeks of gestation to women residents in England in 1995 and 2006.DesignLongitudinal national...

Intrauterine surgery: how far we have come in 30 years.

Intrauterine surgery: how far we have come in 30 years.

Neurodevelopmental outcomes of very low birth weight infants in the Neonatal Research Network of Japan: importance of neonatal intensive care unit graduate follow-up.

Here we describe the neurodevelopmental outcomes of very low birth weight (VLBW) infants (birth weight ≤1,500 g) at 3 years of age in the Neonatal Research Network of Japan (NRNJ) database in the past decade and review the methodological issues identified in follow-up studies. The follow-up protocol for children at 3 years of chronological age in the NRNJ consists of physical and comprehensive neurodevelopmental assessments in each participating center. Neurodevelopmental impairment (NDI)—moderate to severe neurological disability—is defined as cerebral palsy (CP) with a Gross Motor Function Classification System score ≥2, visual impairment such as uni- or bilateral blindness, hearing impairment requiring hearing amplification, or cognitive impairment with a developmental quotient (DQ) of Kyoto Scale of Psychological Development score <70 or judgment as delayed by pediatricians. We used death or NDI as an unfavorable outcome in all study subjects and NDI in survivors using number of assessed infants as the denominator. Follow-up data were collected from 49% of survivors in the database. Infants with follow-up data had lower birth weights and were of younger gestational age than those without follow-up data. Mortality rates of 40,728 VLBW infants born between 2003 and 2012 were 8.2% before discharge and 0.7% after discharge. The impairment rates in the assessed infants were 7.1% for CP, 1.8% for blindness, 0.9% for hearing impairment, 15.9% for a DQ <70, and 19.1% for NDI. The mortality or NDI rate in all study subjects, including infants without follow-up data, was 17.4%, while that in the subjects with outcome data was 32.5%. The NRNJ follow-up study results suggested that children born with a VLBW remained at high risk of NDI in early childhood. It is important to establish a network follow-up protocol and complete assessments with fewer dropouts to enable clarification of the outcomes of registered infants.

27 Determinants of referral to developmental resources among neonatal follow-up patients discharged from tertiary neonatal unit from 2005 UNTIL 2014

Abstract Background Lower gestational age or birth weight and higher rate of neurodevelopmental impairment have been commonly linked to higher need for developmental resources in premature infants. Existing evidence on need for developmental support in premature infants is limited in description of the needs, timing and method of assessment. Objectives To identify predictors for the needs for developmental resources among high-risk groups of infants born less than 29 weeks or with a birth weight (BW) less than 1250 grams. Secondarily, to compare the need of referrals to developmental resources and the rate of neurodevelopmental impairment defined as cerebral palsy, global developmental delay, blindness and deafness for this high risk population. Design/Methods We conducted a retrospective chart review of premature infants &amp;lt; 29+0 weeks GA or BW &amp;lt; 1250 grams born between January 2005 and December 31st 2014, who had at least one visit at the neonatal follow up clinic. Univariate and multivariate logistic regression analyses were conducted to examine potential predictors for referral to developmental resources. Results The study included 687 infants. Within this high risk population, 579 (85.0%) of infants were referred, of these 153 (26.4%) had one referral, 132 (22.8%) had 2 and 294 (50.8%) had 3 or more referral/s to developmental resources. Most frequent referrals were for speech therapy (339, 50.0%) physiotherapy (319, 46.8%) occupational therapy (262, 38.3%) and infant development program (232, 34.1%). The rates of referral to developmental resources decrease with increasing gestational age. Multivariate logistic regressions showed that gestational age (OR: 1.19, 95% CI: 1.05 - 1.35), birth weight (OR: 0.87, 95% CI: 0.77 - 0.99), female gender (OR: 0.70, 95% CI: 0.49 - 0.99), intraventricular hemorrhage grades III-IV (OR: 3.02, 95% CI: 1.28 - 7.16), and days on mechanical ventilator (OR:1.03, 95% CI: 1.01 - 1.05) were predictors for 2 or more referrals to developmental resources. Cerebral palsy was present in 4.4 % of the study population, deafness in 4% and blindness in 0.6%. The rate of referral to developmental resources was 54 (98.2%) among infants with neurodevelopmental impairment (NDI) compared to 522 (83.9%) in infants without NDI (p value= 0.01). Conclusion There is substantial need for developmental support among high-risk premature infants. Infants without neurodevelopmental impairments still need significant developmental resources to achieve their outcome.

42 The Impact of Home Respiratory Support on Developmental Outcomes in Very Preterm Infants

Abstract Introduction/Background Bronchopulmonary dysplasia (BPD) is a common complication of extreme prematurity and may require prolonged home respiratory support. BPD is associated with worse neurodevelopmental outcomes but the impact of home respiratory support on neurodevelopmental outcomes, rehospitalization rates and association with caregiver sociodemographics is less well studied. Objectives This study examines the impact of home respiratory support on neurodevelopmental outcomes in very preterm infants at 18-24 months corrected gestational age. Design/Methods This linked Canadian Neonatal Network and Canadian Neonatal Follow-Up Network (CNFUN) multicenter cohort study of infants born April 1, 2009-December 31, 2016 at &amp;lt;29 weeks’ gestational age assessed at 18-24 months corrected age at a CNFUN site compared significant neurodevelopmental impairment rates, rehospitalization rates and sociodemographics in children with and without home respiratory support using Chi-square and student t-tests. Results Of the 3918 infants, 622 (15.9%) received home respiratory support. As expected, infants on home respiratory support had a lower gestational age (mean 25.5 vs 26.5 weeks, p &amp;lt; 0.01), lower birth weight (mean 781 vs 955 grams, p &amp;lt; 0.01), longer NICU stay (mean 118 vs 76 days, p &amp;lt; 0.01) and more comorbidities: late onset sepsis (35.1% vs 22.9%, p &amp;lt; 0.01), NEC ≥ stage 2 (8.9% vs 5.9%, p = 0.01), grade 3-4 IVH or PVL (12.7% vs 8.4%, p &amp;lt; 0.01) and ROP ≥ grade 3 (28% vs 10.8%, p &amp;lt; 0.01). Infants on home respiratory support had higher significant neurodevelopmental impairment rates defined as Bayley-III motor, cognitive, language scores &amp;lt;70, nonambulatory cerebral palsy (GMFCS ≥ 3), hearing and/or visual impairment rates (Table 1), rehospitalization rates (63.3% vs 29.2%, p &amp;lt; 0.01) and &amp;gt;3 rehospitalizations (19.8% vs 5.0%, p &amp;lt; 0.01). With home respiratory support, fewer families had paid employment and more were on social welfare. Conclusion Children born preterm who are discharged home on respiratory support, compared to those without home support, are more likely to experience neurodevelopmental impairment and rehospitalization, and may have an adverse impact on family income. This is important for discharge planning and follow-up care of these high risk children.

Bevacizumab for Retinopathy of Prematurity: 2-Year Neurodevelopmental Follow-up.

This study aimed to determine whether infants who were treated with intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP) were at higher risk of death or neurodevelopmental impairment (NDI) when compared with infants who were not treated with IVB (Laser only). This retrospective study included 146 infants born from 2009 through 2016 with a birth weight (BW) <1,000 g, gestational age <27 weeks, and required ROP therapy. Death and NDI rates were assessed at 18 to 24 months' corrected age. Rates of death or severe NDI were 62 and 53% in the IVB (n = 61) and Laser only (n = 85) groups, respectively. This difference was not statistically different despite sample selection bias in treating growth-restricted infants with IVB, BW (median [IQR]) was 481 (420-583) versus 547 (473-640) g in IVB and Laser only groups, respectively, p = 0.003. The adjusted odds ratio and 95% confidence interval of death or severe NDI was 0.86 (0.33-2.20). Bevacizumab therapy for ROP did not affect survival and neurodevelopment of extremely preterm infants. · Intravitreal bevacizumab therapy for retinopathy of prematurity may be safe in periviable preterm infants.. · Intravitreal bevacizumab therapy does not increase mortality rate in periviable preterm infants.. · Intravitreal bevacizumab therapy does not increase adverse neurodevelopmental outcome in periviable infants..

ASSOCIATION OF ACUTE KIDNEY INJURY WITH NEURODEVELOPMENTAL OUTCOMES IN INFANTS UNDERGOING SURGERY FOR CONGENITAL HEART DISEASE

Children with congenital heart disease (CHD) have higher rates of neurodevelopmental impairment compared to healthy children. Acute kidney injury (AKI) affects up to 60% of children after surgery for CHD. Kidney injury has been associated with lower academic achievement and worse neurodevelopmental

Relationships Between Early Neonatal Nutrition and Neurodevelopment at School Age in Children Born Very Preterm

The aim of this study was to determine whether a new nutrition protocol designed to increase early protein intakes while reducing fluid volume in infants born very preterm was associated with altered neurodevelopment and growth in childhood. A retrospective, observational cohort study of children born <30 weeks' gestation or <1500 g and admitted to the neonatal unit, National Women's Hospital, Auckland, New Zealand, before and after a change in nutrition protocol. The primary outcome was neurodevelopmental impairment at 7 years (any of Wechsler Intelligence Scale for Children full scale IQ < 85, Movement Assessment Battery for Children-2 total score ≤5th centile, cerebral palsy, blind, or deaf requiring aids). Outcomes were compared between groups and for the overall cohort using generalized linear regression, adjusted for sex and birth weight z score. Of 201 eligible children, 128 (64%) were assessed (55/89 [62%] exposed to the old nutrition protocol, 73 of 112 [65%] to the new protocol). Children who experienced the new protocol received more protein, less energy, and less carbohydrate in postnatal days 1 to 7. Neurodevelopmental impairment was similar at 7 years (30/73 [41%] vs 25/55 [45%], adjusted odds ratio [AOR] [95% confidence interval] 0.78 [0.35-1.70], P = 0.55), as was the incidence of cerebral palsy (AOR 7.36 [0.88-61.40], P = 0.07). Growth and body composition were also similar between groups. An extra 1 g/kg parenteral protein intake in postnatal days 1 to 7 was associated with a 27% increased odds of cerebral palsy (AOR 1.27 [1.03-1.57], P = 0.006). Higher early protein intakes do not change overall rates of neurodevelopmental impairment or growth at 7 years. Further research is needed to determine the effects of higher early parenteral protein intake on motor development.

Home Oxygen and 2-Year Outcomes of Preterm Infants With Bronchopulmonary Dysplasia.

To compare medical and developmental outcomes over the first 2 years of life in extremely preterm infants with bronchopulmonary dysplasia (BPD) who were discharged on supplemental oxygen via nasal cannula with outcomes of infants with a similar severity of respiratory illness who were discharged breathing in room air. We performed a propensity score-matched cohort study. Eligible infants were born at <27 weeks' gestation, were receiving supplemental oxygen or respiratory support at 36 weeks' postmenstrual age, and were assessed at 18 to 26 months' corrected age. Study outcomes included growth, resource use, and neurodevelopment between discharge and follow-up. Outcomes were compared by using multivariable models adjusted for center and age at follow-up. A total of 1039 infants discharged on supplemental oxygen were propensity score matched 1:1 to infants discharged breathing in room air. Infants on oxygen had a marginal improvement in weight z score (adjusted mean difference 0.11; 95% confidence interval [CI] 0.00 to 0.22), with a significantly improved weight-for-length z score (adjusted mean difference 0.13; 95% CI 0.06 to 0.20) at 22 to 26 months' corrected age. Infants on oxygen were more likely to be rehospitalized for respiratory illness (adjusted relative risk 1.33; 95% CI 1.16 to 1.53) and more likely to use respiratory medications and equipment. Rates of neurodevelopmental impairment were similar between the groups. In this matched cohort of infants with BPD, postdischarge oxygen was associated with marginally improved growth and increased resource use but no difference in neurodevelopmental outcomes. Ongoing and future trials are critical to assess the efficacy and safety of postdischarge supplemental oxygen for infants with BPD.

Outcomes and resource usage of infants born at ≤ 25 weeks gestation in Canada.

To determine the outcomes and resource usage of infants born at ≤ 25 weeks gestational age (GA). Retrospective study of infants born between April 2009 and September 2011 at ≤ 25 weeks' GA in all neonatal intensive care units in Canada with follow-up in the neonatal follow-up clinics. Short-term morbidities, neurodevelopmental impairment, significant neurodevelopmental impairment, and resource utilization of infants born at ≤ 24 weeks were compared with neonates born at 25 weeks. Of 803 neonates discharged alive, 636 (80.4%) infants born at ≤ 25 weeks' GA were assessed at 18 to 24 months. Caesarean delivery, lower birth weight, and less antenatal steroid exposure were more common in infants born ≤ 24 weeks as compared with 25 weeks. They had significantly higher incidences of ductus arteriosus ligation, severe intracranial hemorrhage, retinopathy of prematurity as well as longer length of stay, central line days, days on respiratory support, days on total parenteral nutrition, days on antibiotics, and need for postnatal steroids. Neurodevelopmental impairment rates were 68.9, 64.5, and 55.6% (P=0.01) and significant neurodevelopmental impairment rates were 39.3, 29.6, and 20.9% (P<0.01) for infants ≤ 23, 24, and 25 weeks GA, respectively. Postdischarge service referrals were higher for those ≤ 23 weeks. Nonsurviving infants born at 25 weeks GA had higher resource utilization during admission than infants born less than 25 weeks. Adverse outcomes and resource usage were significantly higher among infants born ≤ 24 weeks GA as compared with 25 weeks GA.

Sex Differences in Mortality and Morbidity of Infants Born at Less Than 30 Weeks’ Gestation

To examine whether changes in mortality and morbidities have benefited male more than female infants. Infants of gestational ages 22 to 29 weeks born between January 2006 and December 2016 at a Vermont Oxford Network center in the United States were studied. We examined mortality and morbidity rate differences and 95% confidence intervals by sex and birth year. We tested temporal differences in mortality and morbidity rates between boys and girls by means of a likelihood ratio test (LRT) on nested binomial regression models with log links. A total of 205 750 infants were studied; 97 048 (47.2%) infants were girls. The rate for mortality and chronic lung disease decreased over time faster for boys than for girls (LRT P < .001 for mortality; P = .006 for lung disease). Restricting to centers that remained throughout the entire study period did not change all the above but additionally revealed a significant year-sex interaction for respiratory distress syndrome, with a faster decline among boys (LRT P = .04). Morbidities, including patent ductus arteriosus, necrotizing enterocolitis, early-onset sepsis, late-onset sepsis, severe intraventricular hemorrhage, severe retinopathy of prematurity, and pneumothorax, revealed a constant rate difference between boys and girls over time. Compared with girls, male infants born at <30 weeks' gestation experienced faster declines in mortality, respiratory distress syndrome, and chronic lung disease over an 11-year period. Future research should investigate which causes of death declined among boys and whether their improved survival has been accompanied by a change in their neurodevelopmental impairment rate.

Influence of Maternal Preeclampsia on Neurodevelopmental Outcomes of Preterm Infants

Objective: The aim of this study was to determine the neurodevelopmental outcome of preterm infants born to mothers with preeclampsia and to compare them with preterm controls.Study design: This was a retrospective, observational study in a large, tertiary, neonatal intensive care unit. Neurodevelopmental evaluations using Bayley Scales of Infant Development II were performed in 226 two-year-old infants with birth weight ≤1500 g and gestational age ≤32 weeks who were born to mothers with preeclampsia and in 493 infants who were born after normotensive pregnancies, matched for gestational age and gender.Results: The mean gestational ages of the infants in the preeclampsia and control groups were 29.9±2.3 weeks and 28.7±4.1 weeks, respectively (p&lt;0.001). A total of 372 infants with a mean age of 19.2±3.2 months were assessed for long-term outcome. The mean mental developmental index score was significantly higher, and the percentage of infants with cerebral palsy was significantly lower, in the preeclampsia group compared with the control group (p=0.03 and p=0.02, respectively). However, no overall significant differences in neurodevelopmental impairment rates were found between the two groups (p=0.08).Conclusion: Maternal preeclampsia seems to be a protector factor for the development of cerebral palsy in preterm infants.

Are Neurodevelopmental Outcomes of Infants Born Extremely Preterm Improving Over Time?

* Abbreviations: Bayley-III — : Bayley Scales of Infant and Toddler Development, Third Edition NDI — : neurodevelopmental impairment NRN — : Neonatal Research Network Accurate data on rates of mortality and of neurodevelopmental impairment (NDI) in survivors are critical in decision-making for infants born at 22 to 24 weeks’ gestation, the borderline of viability. Despite many studies reporting on mortality and NDI rates, it is concerning that health care professionals continue to overestimate rates of mortality and NDI of infants at the borderline of viability.1 Because survival rates may have plateaued in recent years,2 there is an increasing emphasis on their rates of NDI. In the current issue of Pediatrics , Adams-Chapman et al3 from the Neonatal Research Network (NRN) hypothesized that NDI in children born at <27 completed weeks’ gestation would decrease over a 3.75-year period beginning in 2011. The authors reported on neurodevelopmental outcomes at 18 to 26 months’ corrected age for 2113 children who had been born and cared for in an NRN center and who were involved in the NRN’s follow-up study. NDI comprised any of the following: gross motor impairment as defined by using a Gross Motor Function Classification System4 of level 2 or more; a Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III)5 cognitive or motor score <70; bilateral blindness; or hearing impairment. The rate of NDI did … Address correspondence to Lex W. Doyle, MD, MSc, FRACP, Research Precinct, Level 7, The Royal Women’s Hospital, 20 Flemington Rd, Parkville, VIC 3052, Australia. E-mail: lwd{at}unimelb.edu.au

Long-Term Neurodevelopmental Outcomes of Premature Infants in Singapore

Neonatal care advances have resulted in improved survival but have raised concerns of increase in neurodevelopmental impairment. This study looked at long-term neurodevelopmental outcomes at ages 5 and 8 years of very low birthweight infants born in the 2000s as compared to the 1990s. Neurodevelopmental assessment at 2 years old was compared to that at 5 and 8 years to determine if assessment at 2 years was predictive of later outcomes. A retrospective cohort study of consecutive infants with birthweight less than 1250 grams admitted to a tertiary centre in Singapore between January 1994 to December 1995 (Epoch I) and January 2004 to December 2005 (Epoch II) were included. Neurodevelopmental impairment was defined as having intelligence quotient (IQ) of less than 70, cerebral palsy, legal blindness, or hearing impairment requiring hearing aids. Mean gestational age was lower for Epoch II compared to Epoch I (28.1 ± 2.5 vs 29.4 ± 2.7 weeks, P = 0.004). Death or neurodevelopmental impairment rates did not differ (24.3% and 17.1% at 5 years old, P = 0.398; 29.1% and 25.0% at 8 years old, P = 0.709). There was improvement in visual impairment rate at 8 years in Epoch II (10.7% vs 34.0%, P = 0.024). Mean IQ was better in Epoch II (109 and 107 vs 97 and 99 at 5 [P = 0.001] and 8 years [P = 0.047], respectively). All infants with no neurodevelopmental impairment at 2 years remained without impairment later on. Over a decade, neurodevelopmental outcomes did not worsen despite lower mean gestational age. Long- term improvement in IQ scores and a reduction in visual impairment rates were seen. Our data suggests that children without neurodevelopmental impairment at 2 years are without impairment later on; therefore, they may need only developmental monitoring with targeted assessments instead of routine formal IQ assessments.

Update on Phototherapy in Jaundiced Neonates.

Even relatively low serum bilirubin concentrations can cause neurodevelopmental impairment in extremely low birth weight (EBWL) infants, while sequelae from hyperbilirubinemia in late preterm and term infants are rare and occur only at very high serum bilirubin levels. Phototherapy is the current treatment of choice. To present an update on the most important issues involved in phototherapy for jaundiced infants. Light absorption by bilirubin in the skin transforms the native Z,Z-bilirubin to conformational photoisomers Z,E-bilirubin and E,Z-bilirubin and structural photoisomers E,Z-lumirubin and E,E-lumirubin. Formation and excretion of Z,E-bilirubin and E,Z-lumirubin are both important routes of elimination of bilirubin through bile and urine, although the precise contributions of the various photoisomers to the overall elimination of bilirubin are unknown. It appears that the photoisomers of bilirubin are predominantly formed in the plasma, and the rate of formation is affected by the hemoglobin concentration. Phototherapy lights with an emission spectrum of 460-490 nm provide the most efficient bilirubin-reducing light. LEDs should replace fluorescent tubes and halogen spotlights as the preferred light sources. Recent data raise concerns that sick ELBW infants under prolonged phototherapy may have an increased risk of death, though survivors may benefit from reduced rates of neurodevelopmental impairment. Comparison of the efficacy of cycled vs. continuous phototherapy has given divergent results. Changing the infant's position does not increase the efficacy of phototherapy. During the last decade, we have made progress in our understanding of how and where phototherapy works and in its practical applications.

Survival, Short-Term, and Long-Term Morbidities of Neonates with Birth Weight < 500 g.

Objectives The objective of this study was to describe survival, short-term, and long-term morbidities of neonates with birth weight &lt; 500 g. Study Design Retrospective cohort studies to calculate survival, short-term, and long-term morbidity rates of neonates born weighing &lt; 500 g from 1993 to 2012 and neurodevelopmental impairment rates at 4.5 years for births 1993 to 2008 in one center. Results Of 549 inborn neonates with birth weight &lt; 500 g, 4% survived. For live births and neonatal intensive care unit (NICU) admissions, 10 and 55% survived, respectively. Of 28 NICU (inborn and outborn) survivors (median birth weight 460 g and gestation 25.9 weeks [range: 22.6–30.3 weeks]), 71% were inborn, 50% male, and 75% were small for gestational age. One in five neonates was a twin or multiple. Short-term morbidities noted were bronchopulmonary dysplasia (91%), culture proven sepsis (50%), retinopathy of prematurity (41%), and severe brain injury (22%); 27% had no long-term impairment, 23% one, 23% two, 18% three, and 9% four impairments in motor, cognitive, vision, and/or hearing domains. At 4.5 years, 29% had visual impairment, 10% wore hearing aids, 50% had IQ &lt; 70, 18% cerebral palsy, and 68% had low motor scores. Conclusion Only 4% of births &lt; 500 g survived. All survivors had short-term morbidities; 27% neonates survived without long-term major impairments.

Early-Onset Invasive Candidiasis in Extremely Low Birth Weight Infants: Perinatal Acquisition Predicts Poor Outcome.

Neonatal invasive candidiasis (IC) presenting in the first week of life is less common and less well described than later-onset IC. Risk factors, clinical features, and disease outcomes have not been studied in early-onset disease (EOD, ≤7 days) or compared to late-onset disease (LOD, >7 days). All extremely low birth weight (ELBW, <1000 g) cases with IC and controls from a multicenter study of neonatal candidiasis enrolled from 2001 to 2003 were included in this study. Factors associated with occurrence and outcome of EOD in ELBW infants were determined. Forty-five ELBW infants and their 84 matched controls were included. Fourteen (31%) ELBW infants had EOD. Birth weight <750 g, gestation <25 weeks, chorioamnionitis, and vaginal delivery were all strongly associated with EOD. Infection with Candida albicans, disseminated disease, pneumonia, and cardiovascular disease were significantly more common in EOD than in LOD. The EOD case fatality rate (71%) was higher than in LOD (32%) or controls (15%) (P = .0001). The rate of neurodevelopmental impairment and mortality combined was similar in EOD (86%) and LOD (72%), but higher than in controls (32%; P = .007). ELBW infants with EOD have a very poor prognosis compared to those with LOD. The role of perinatal transmission in EOD is supported by its association with chorioamnionitis, vaginal delivery, and pneumonia. Dissemination and cardiovascular involvement are common, and affected infants often die. Empiric treatment should be considered for ELBW infants delivered vaginally who have pneumonia and whose mothers have chorioamnionitis or an intrauterine foreign body.

The Validity of the Bayley-III and DDST-II in Preterm Infants With Neurodevelopmental Impairment: A Pilot Study.

ObjectiveTo identify the usefulness of both the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) and Denver Developmental Screening Test II (DDST-II) in preterm babies with neurodevelopmental impairment, considering the detection rate as regulation of criteria.MethodsRetrospective medical chart reviews which included the Bayley-III and DDST-II, were conducted for 69 preterm babies. Detection rate of neurodevelopmental impairment in preterm babies were investigated by modulating scaled score of the Bayley-III. The detection rate of DDST-II was identified by regarding more than 1 caution as an abnormality. Then detection rates of each corrected age group were verified using conventional criteria.ResultsWhen applying conventional criteria, 22 infants and 35 infants were detected as preterm babies with neurodevelopmental impairment, as per the Bayley-III and DDST-II evaluation, respectively. Detection rates increased by applying abnormal criteria that specified as less than 11 points in the Bayley-III scaled score. In DDST-II, detection rates rose from 50% to 68.6% using modified criteria. The detection rates were highest when performed after 12 months corrected age, being 100% in DDST II. The detection rate also increased when applying the modified criteria in both the Bayley-III and DDST-II.ConclusionAccurate neurologic examination is more important for detection of preterm babies with neurodevelopmental impairment. We suggest further studies for the accurate modification of the detection criteria in DDST-II and the Bayley-III for preterm babies.

Preschool Assessment of Preterm Infants Treated With Darbepoetin and Erythropoietin.

We previously reported improved neurodevelopmental outcomes at 2 years among infants treated with the erythropoiesis-stimulating agents (ESAs) darbepoetin alfa (darbepoetin) or erythropoietin. Here we characterize 4-year outcomes. Former preterm infants randomly assigned to receive darbepoetin (10 μg/kg, once per week), erythropoietin (400 U/kg, 3 times/week), or placebo through 35 weeks' postconceptual age were evaluated at 3.5 to 4 years of age. For comparison, healthy children formerly delivered full term (term controls [TCs]) were also recruited. All participants were assessed by using measures of full-scale IQ (FSIQ) and general language from the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, and an overall measure of executive function, on the basis of tests evaluating inhibitory control and spatial working memory. Rates of neurodevelopmental impairment were compared across groups. Multivariate analysis of variance compared children randomly assigned to ESAs (n = 39), placebo (n =14), and TCs (n = 24). FSIQ and performance IQ were significantly higher in the ESA group than in the placebo group (FSIQ: 91.1 ± 17.5 vs 79.2 ± 18.5, P = .036; performance IQ: 93.0 ± 17.0 vs 79.5 ± 19.5, P = .018). Follow-up analyses revealed that the children receiving ESAs performed better than those who received placebo on executive function tasks. The ESA group's performance was below that of TCs, but the results did not reach significance on executive function. The incidence of neurodevelopmental impairment was greater in the placebo group than in the ESA group. ESA-treated infants had better cognitive outcomes and less developmental impairment at 3.5 to 4 years of age compared with placebo-treated infants. ESAs show promise in improving long-term cognitive outcomes of infants born prematurely.

Does High Protein Intake During First Week of Life Improve Growth and Neurodevelopmental Outcome at 18 months Corrected Age in Extremely Preterm Infants?

To examine whether high protein intake during the first week of life alters the growth and neurodevelopmental outcomes at 18mo corrected age (CA) in preterm infants born < 29wk. This was a retrospective cohort study of preterm infants (<29wk) before and after introduction of nutritional policy targeting higher protein intake during the first week of life. The authors compared the growth and neurodevelopmental outcomes at 18mo CA between infants born before (epoch 1) and after (epoch 2) the introduction of nutrition policy. Of 171 eligible infants who completed follow-up at 18mo CA, 87 (51%) were in post intervention group (epoch 2). The mean (± SD) gestational age (26.3 ± 1.49wk vs. 26.2 ± 1.48wk) and birth weight (947 ± 220g vs. 924 ± 225g) were similar between the two groups. At 18mo CA, there were no significant differences in the growth and neurodevelopmental impairment rates between the two groups. Logistic regression analysis revealed that high protein intake (>3.5g/kg/d) was not associated with improved neurodevelopmental outcome (OR 1.49, 95% CI 0.52-4.26). High protein intake during the first week of age was not associated with better growth or neurodevelopmental outcome at 18mo CA in preterm infants.