Identifying the Critical Threshold for Long-Term Pediatric Neurological Hospitalizations of the Offspring in Preterm Delivery

Abstract

We opted to investigate whether a critical threshold exists for long-term pediatric neurological morbidity, and cerebral palsy (CP), in preterm delivery, via a population-based cohort analysis. Four study groups were classified according to their gestational age at birth: 24–27.6, 28–31.6, 32–36.6 weeks and term deliveries, evaluating the incidence of long-term hospitalizations of the offspring due to neurological morbidity. Cox proportional hazard models were performed to control for confounders. A Kaplan–Meier survival curve was used to compare the cumulative neurological morbidity incidence for each group. A total of 220,563 deliveries were included: 0.1% (118) occurred at 24–27.6 weeks of gestation, 0.4% (776) occurred at 28–31.6 weeks of gestation, 6% (13,308) occurred at 32–36.6 weeks of gestation and 93% (206,361) at term. In a Cox model, while adjusting for confounders, delivery before 25 weeks had a 3.9-fold risk for long-term neurological morbidity (adjusted HR (hazard ratio) = 3.9, 95% CI (confidence interval) 2.3–6.6; p < 0.001). The Kaplan–Meier survival curve demonstrated a linear association between long-term neurological morbidity and decreasing gestational age. In a second Cox model, adjusted for confounders, infants born before 25 weeks of gestation had increased rates of CP (adjusted HR = 62.495% CI 25.6–152.4; p < 0.001). In our population, the critical cut-off for long-term neurological complications is delivery before 25 weeks gestation.

Low Five-Minute Apgar Score and Neurological Morbidities: Does Prematurity Modify the Association?

“…The brain of premature newborns is not fully developed, as well as the lungs and other systems, making them more susceptible and vulnerable to harmful exposures. Due to the intensive care and interventions they undergo, the rates of many neurological complications, with possible long-term consequences, are higher among offspring born premature, and the risk increases with earlier gestational age at delivery [ 17 , 18 , 19 ].…”

“Advances in Preterm Delivery”—How Can We Advance Further?

“…Preterm delivery (PTD: <37 gestational weeks) complicates 5–13% of deliveries worldwide [ 1 ], and is a leading cause of perinatal and childhood mortality and morbidity [ 2 , 3 , 4 , 5 ]. PTD is also a risk factor for long-term maternal health complications, including cardiovascular and renal morbidities [ 6 , 7 ].…”

“…Fetal development occurs throughout the entire pregnancy until full term; therefore, when PTD occurs, the newborn is not physiologically and metabolically mature, leading to immediate and long-term complications [ 2 , 3 , 4 , 5 ]. The severity of these complications depends mainly on gestational age at delivery, and increases with reduced gestational age; this is reported by Gutvirtz et al [ 3 ] and Zer at al.…”

“…The severity of these complications depends mainly on gestational age at delivery, and increases with reduced gestational age; this is reported by Gutvirtz et al [ 3 ] and Zer at al. [ 4 ] in our Special Issue, in their works regarding risk of prematurity and respiratory or neurologic morbidities in offspring. In a large retrospective cohort, Gutvirtz et al [ 3 ] found that offspring born at an extremely premature gestational age were ~3 times more likely to be hospitalized with respiratory morbidities, and Zer at al.…”

“…In a large retrospective cohort, Gutvirtz et al [ 3 ] found that offspring born at an extremely premature gestational age were ~3 times more likely to be hospitalized with respiratory morbidities, and Zer at al. [ 4 ] found that they were ~3.9 times more likely to be hospitalized with neurologic morbidities, compared to offspring born at term. Besides immediate and long-term health effects, PTD entails great economic consequences due to health costs, and the support of families and their offspring throughout life; this begins with the immediate hospitalization and intensive care treatment upon delivery.…”