Neurodevelopmental Status of Preterm Newborns at Infancy, Born at a Tertiary Care Center in Turkey

Abstract

Our objective was to determine the incidence of early neonatal problems and the neurodevelopmental status and probable risk factors associated with neurodevelopmental abnormality in preterm infants of < or = 32 weeks of gestation. Preterm newborns of < or = 32 weeks of gestation followed at the neonatal intensive care unit of the Department of Pediatrics of Gülhane Military Medical Academy, Ankara, Turkey, were evaluated with a complete neurological examination and the Bayley Scales of Infant Development at a mean age of 25.85 + or - 11.79 months (range, 10 to 42 months). Multivariate logistic regression analyses were performed to determine the probable risk factors associated with neurodevelopmental abnormalities. Regarding the results of the neurological examination in a total of 169 preterms included in the study, 28 (16.6%) and 14 (8.3%) patients were determined to have mild neurological dysfunction or cerebral palsy, respectively. The rate of psychomotor abnormality according to a low Bayley Psychomotor Development Index (PDI) score was 24.8%, and the rate of mental/cognitive abnormality on the basis of a low Bayley Mental Development Index (MDI) score was 25.4%. In the subgroup of infants with < or = 29 weeks of gestational age (n = 55); 22 (40%) patients had an abnormal neurological examination, and 24 (43.6%) and 23 (41.8%) patients had low Bayley PDI and MDI scores, respectively. In the study group, logistic regression analysis revealed the significant predictors of an abnormal neurological examination to be the duration of mechanical ventilation (odds ratio [OR], 1.133; 95% confidence interval [CI], 1.062 to 1.208) and necrotizing enterocolitis (OR, 6.697; 95% CI, 1.776 to 25.252). One of the major conclusions of the present study is the risk of neurodevelopmental sequelae in one of every four preterm infants with <32 weeks of gestation and the need for follow-up in this group. Measures in neonatal care and treatment, such as the use of less traumatic modes of mechanical ventilation with as short duration as possible as well as increasing perinatal/antenatal care, should be taken to overcome these risk factors.

Developmental outcome of very low birth weight infants in a developing country

“…Duration of intensive care showed a trend towards worse outcome. These findings were similar to those reported in other studies where NEC [24-28], gender [7,26,29-33], chronic lung disease [3,7,32,34], respiratory distress [35,36], multiple birth [7], HIV infection [37], cranial sonar findings [29,38-41], particularly PVL [15,26,31,42,43] and intraventricular haemorrhage, [26,44,45]), neonatal seizures [26,44], perinatal asphyxia [41,44,45], neonatal sepsis [27,41], postnatal steroids [31,33,34] and the duration of assisted ventilation [24,26,30] have all been associated with adverse neurodevelopmental outcome in VLBW infants. Gestational age [3,35,46] and birth weight [10,30,46] have both been reported as predictors of poor neurodevelopmental outcome.…”

“…A group of Finnish infants born between 2001 and 2006 were assessed at 2 years of age and 9.9% were found to have neurodevelopmental impairment. The outcome of preterm infants below 32 weeks born at a tertiary centre in Ankara in Turkey, 16.6% were found to have minor neurological dysfunction and 8.3% to have cerebral palsy at a median age of 25.85 months [24]. Of this group, 24.8% had a low Bayley Psychomotor development index and 25.4% a low Bayley Mental Development index.…”

A study on neurodevelopmental outcome and its associated risk factors in very low birth weight babies in a tertiary care teaching hospital in Kolkata

“…In the present study, birth weight < 1000 g, gestational age < 30 weeks, use of antenatal steroid, Apgar score at 5 minutes< 6, need for active resuscitation at birth, need for ventilation, hypoglycaemia, sepsis and presence of IVH had correlation with abnormal neurodevelopmental outcomes and their association with abnormal outcomes were statistically significant. These findings were similar to those reported in other studies where birth weight, 18 gestational age, 19 perinatal asphyxia, 20 neonatal sepsis, 21 IVH, 20,22 respiratory distress, 19 duration of assisted ventilation 18,23 have all been associated with adverse neurodevelopmental outcome in VLBW babies.…”

Role of Gender in Morbidity and Mortality of Extremely Premature Neonates

“…Earlier investigations have indicated a correlation between short-term adverse outcomes and long-term neurodevelopmental prognosis. 34,35 Our study demonstrates that the female advantage regarding the occurrence of respiratory complications still remains after the introduction of surfactant and antenatal corticosteroids, suggesting that these treatments cannot completely overcome the pulmonary development delay experienced by male preterm infants. Because males remain at higher risk of RDS and BPD, 36 it is possible that antenatal corticosteroids do not benefit them as much as they do premature female infants.…”