Neuromotor Development Evaluation of Preterm Babies Less than 34 Weeks of Gestation with Bayley III at 18‐24 Months

Abstract

Objectives. To assess and evaluate the risk factors affecting the neuromotor development of preterm babies at corrected age 18 to 24 months. Methods. Preterm babies ≤ 34 weeks of gestational age (GA) who were born in our hospital between 2011 and 2014 were prospectively included in the study. Prenatal, perinatal, and postnatal features of the babies were recorded. Bayley Scales of Infants and Toddler Development, Third Edition (Bayley-III), was applied at corrected age 18 to 24 months. Results. All data of 96 babies were obtained during the study, mean birth weight was 1542 ± 518 g, and mean corrected age was 20.9 ± 4.7 months. Cerebral palsy was found in 11 babies (11.5%). According to Bayley III scores, 13.5% cognitive delay, 19.8% language delay, and 33.3% motor delay rations were detected. A positive correlation was found between GA and motor composite scores ( p = 0.011 ). The mean motor composite score was lower in babies with the Apgar score less than 7 at 1st and 5th minutes ( p = 0.007 and p = 0.003 ) and applied resuscitation in the delivery room ( p = 0.033 ). The mean language composite score was found to be higher in babies with antenatal steroid administration ( p = 0.003 ). A negative correlation was found between the motor composite score and the oxygen treatment time and mechanical ventilation support time ( p = 0.001 and p = 0.007 ). Conclusion. In preterm babies less than 34 weeks, the birth weight, GA, Apgar score, oxygen treatment time, mechanical ventilation support time, and resuscitation in a delivery room were determined to affect the Bayley III motor score. Language development was found better in babies with antenatal steroid administration.

Evaluation of Long-term Outcomes Associated With Preterm Exposure to Antenatal Corticosteroids

“…After excluding 4802 duplicate records, we screened 8577 titles and abstracts and assessed 342 full-text articles. A total of 30 cohort studies met the final inclusion criteria that, together, involved more than 1.25 million children who were at least 1 year of age when the outcomes were assessed (Table 1; eTable 1 in the Supplement); the justifications for excluding other important studies are provided in eAppendix 2 in the Supplement. Race and ethnicity categories were reported in 6 studies (eTable 1 in the Supplement).…”

“…Of the 30 studies included, 26 focused on neurodevelopmental and/or psychological outcomes (eTables 2-6 in the Supplement), 3 had data on both neurodevelopmental and/or psychological outcomes and other outcomes (eTables 2-7 in the Supplement), and 1 included data on other outcomes (eTable 7 in the Supplement). The duration of participant follow-up ranged from 1 to 10 years (Table 1).…”

“…Twenty of the 30 included studies had long-term outcomes for children who were exposed to an unspecified number of courses of antenatal corticosteroids vs those who were unexposed; however, most of these studies likely included a single course of antenatal corticosteroids because that was the most common clinical scenario during the study period (Table 1; eTables 4 and 5, eFigures 1-3 in the Supplement). Two studies (Räikkönen et al and Wolford et al) addressed the primary outcome of an author-defined composite of any adverse neurodevelopmental and/or psychological disorder (Figure 3), whereas another study (Lamminmäki et al) addressed individual psychological outcomes (eTable 4 in the Supplement). Räikkönen et al reported a significantly elevated risk of any mental or behavioral disorder in children with preterm and full-term birth that was associated with exposure to an unspecified number of courses of antenatal corticosteroids vs nonexposure (670 097 children; adjusted hazard ratio [aHR], 1.33 [95% CI, 1.26-1.41]; low certainty) (Table 2).…”

Early Neurodevelopmental Outcomes after Previable Preterm Prelabour Rupture of Membranes (pPPROM)

“…Prematurity is a known risk factor for long-term disability [12][13][14]. At 2 years of age, there is a higher incidence of motor delay in children born preterm with almost one-third having Bayley-III motor scores below 85 [15]. Very preterm birth-particularly in the setting of intrauterine infection-is strongly associated with severe neurodevelopmental impairment, including cerebral palsy [13,[15][16][17][18][19][20].…”

“…At 2 years of age, there is a higher incidence of motor delay in children born preterm with almost one-third having Bayley-III motor scores below 85 [15]. Very preterm birth-particularly in the setting of intrauterine infection-is strongly associated with severe neurodevelopmental impairment, including cerebral palsy [13,[15][16][17][18][19][20]. However, reports on the frequency of chorioamnionitis in the setting of PPROM are highly variable and range between 40% and 93% [19,21].…”