2019 Congress of the Italian Society of Neonatology

Abstract

Introduction: Neurodevelopmental impairment is a major long-term complication for a variable number of extremely low gestation neonates (ELGAN). Rates of survival have increased during the past 2 decades however neuromotor disabilities have not decreased. Objective: The aim of this study was to obtain neurodevelopmental disabilities at 2 years corrected age of infants born in the Marche Region between 24 0/7 and 31 6/7 weeks' gestation from 2010 to 2016. Methods/Design: Retrospective evaluation of two-year follow-up data prospectively collected for all infants born at 24 0/7 to 31 6/7 weeks' gestation admitted to the NICU of the Salesi Children's Hospital, Ancona, from January 2010 to December 2016. Exclusion criteria were major congenital malformations and admission after 48 hours of life. Cognitive (from 2010), motor (from 2010) and language (from 2014) development were assessed with Bayley Scales of Infant and Toddler Development 3rd edition and cerebral palsy was graded with Gross Motor Function Classification System (GMFCS). Visual and hearing data were also collected. Moderate and severe impairment (NDI) was defined as: a GMFCS ≥3, unilateral or bilateral blindness, hearing loss improved or not by aids or a developmental score ≤2 SDS. Results: 630 infants admitted to our NICU in the study period were included. Forty-four (6.9%) died before 24 months of age. Five hundred eighty-six infants were eligible for the follow up. Eighty-eight (15%) were lost (missing data, failed to bring their children/moved away, declined the invitation, untraceable to the telephone call). 498 infants were available for the 2y follow-up. Birth weight was 1194 g ± 356; mean GA 204 days ± 14, 258 (52%) were males. Infants with extreme prematurity (24 0/7-27 6/7) were 132 and 366 were very preterm (28 0/7-31 6/7). Mean cognitive composite (n=489) score was 94±14, motor score (n= 490) 101±13 and language score (n=151) 96±18. Mild visual impairment was present in 15 infants (3%). Any hearing impairment was present in 3 (0.6%), with only 1 severe (bilateral deafness not improved by aids). Cerebral Palsy was diagnosed in 15 infants (3.2%): moderate (GMFCS 3) in 4 (0.8%) and severe (GMFCS 4-5) in 7 (1.4%). Moderate and severe NDI was found in 32 infants (6.4%): 13 extreme preterms and 19 very preterms. Birth weight and gender were significantly associated with overall neurodevelopmental impairment (p=0.030, p=0.002 and p<0.001 respectively), but only gender was associated with moderate-severe outcome (p=0.026). Conclusion: Preterm infants of the Marche Neonatal Network cohort born from 2010 to 2016 had relative low rate of moderate-severe