Early Childhood Development of Late-Preterm Infants: A Systematic Review

Abstract

CONTEXT: Late-preterm infants (LPIs) born at 34 to 36 weeks' gestation are increasingly regarded as being at risk for adverse developmental outcomes. To date, the early childhood development of LPIs has not been systematically considered. OBJECTIVE: To undertake a broad examination of literature relating to early childhood development at the ages of 1 to 7 years of LPIs born at 34 to 36 weeks' gestation. METHODS: We conducted a systematic review of early childhood outcomes in LPIs by using 9 electronic databases (January 1980 to March 2010). Bibliographies were reviewed. After examination of abstracts, ineligible studies were excluded. A specifically designed data-extraction form was used. The methodologic quality of included studies was assessed by using well-documented quality-appraisal guidelines. RESULTS: Of 4581 studies, 10 (3 prospective and 7 retrospective cohort) were included. Studies were heterogeneous, and poorer outcomes were reported among LPIs in relation to neurodevelopmental disabilities, educational ability, early-intervention requirements, medical disabilities, and physical growth in comparison to term-born children. No identified study used healthy nonadmitted LPIs as a comparison group for admitted LPIs. CONCLUSIONS: Evidence suggests that LPIs are at increased risk of adverse developmental outcomes and academic difficulties up to 7 years of age in comparison to term infants. An infant control group matched for gestational age has not been used; thus, for LPIs, the effect of neonatal admission on longer-term outcomes has not been fully explored. Systematic measurement of early childhood outcomes is lacking, and focused long-term follow-up studies are needed to investigate early childhood development after late-preterm birth.

Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial

“…However, there is increasing concern about the risks of adverse outcome for late preterm neonates, with studies identifying an increased risk of neonatal morbidity 22 , rehospitalisation in early childhood 23 and academic difficulties in children at school age 24 . These risks are thought to be associated with both gestational age and biological factors associated with the preterm birth, including PPROM 25 , however, immediate delivery does not appear to improve outcomes in preterm neonates and may exacerbate the risks of prematurity because of birth in the absence of labor and earlier gestational age.…”

Neonatal Morbidities and Developmental Delay in Moderately Preterm-Born Children

“…Apart from the risk of neonatal morbidities, moderately preterm-born children are also more likely to have developmental delays at preschool age. [7][8][9] Particularly in moderately preterm-born children, it remains unclear whether these neonatal morbidities are associated with the increased risk of developmental delay. 9 In the general population, male gender, small-for-gestational-age (SGA) status at birth, decreasing gestational age, and low maternal education increase the risk of developmental delay.…”

Correcting for prematurity affects developmental test scores in infants born late and moderately preterm

“…[1] Children born at these gestations are at higher risk for developmental delay, cognitive deficits, attention problems and special educational needs than their term-born peers. [2][3][4][5] These problems are evident in infancy and recent population-based studies have shown that children born LMPT are at twice the risk for neurodevelopmental disability compared with term-born controls at two years of age. [6] Developmental assessments in the early years are regarded as important for identifying children at risk and for targeting early intervention.…”