Early-Childhood Neurodevelopmental Outcomes Are Not Improving for Infants Born at <25 Weeks' Gestational Age

Susan R HINTZ; Douglas E KENDRICK; Deanne E WILSON-COSTELLO; Abhik DAS; Edward F BELL; Betty R VOHR; Rosemary D HIGGINS; NICHD Neonatal Research Network

doi:10.1542/peds.2010-1150

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Early-Childhood Neurodevelopmental Outcomes Are Not Improving for Infants Born at <25 Weeks' Gestational Age

Journal article

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Early-Childhood Neurodevelopmental Outcomes Are Not Improving for Infants Born at <25 Weeks' Gestational Age

Susan R HINTZ, Douglas E KENDRICK, Deanne E WILSON-COSTELLO, Abhik DAS, Edward F BELL, Betty R VOHR, Rosemary D HIGGINS and NICHD Neonatal Research Network

Pediatrics (Evanston), Vol.127(1), pp.62-70

2011

DOI: 10.1542/peds.2010-1150

PMCID: PMC3375467

PMID: 21187312

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Abstract

OBJECTIVE: We compared neurodevelopmental outcomes at 18 to 22 months' corrected age of infants born with extremely low birth weight at an estimated gestational age of <25 weeks during 2 periods: 1999–2001 (epoch 1) and 2002–2004 (epoch 2). PATIENTS AND METHODS: We conducted a multicenter, retrospective analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Perinatal and neonatal variables and outcomes were compared between epochs. Neurodevelopmental outcomes at 18 to 22 months' corrected age were evaluated with neurologic exams and Bayley Scales of Infant Development II. Logistic regression analyses determined the independent risk of epoch for adverse outcomes. RESULTS: Infant survival was similar between epochs (epoch 1, 35.4%, vs epoch 2, 32.3%; P = .09). A total of 411 of 452 surviving infants in epoch 1 and 405 of 438 surviving infants in epoch 2 were evaluated at 18 to 22 months' corrected age. Cesarean delivery (P = .03), surgery for patent ductus arteriosus (P = .004), and late sepsis (P = .01) were more common in epoch 2, but postnatal steroid use was dramatically reduced (63.5% vs 32.8%; P < .0001). Adverse outcomes at 18 to 22 months' corrected age were common in both epochs. Moderate-to-severe cerebral palsy was diagnosed in 11.1% of surviving infants in epoch 1 and 14.9% in epoch 2 (adjusted odds ratio [OR]: 1.52 [95% confidence interval (CI): 0.86–2.71]; P = .15), the Mental Developmental Index was <70 in 44.9% in epoch 1 and 51% in epoch 2 (OR: 1.30 [95% CI: 0.91–1.87]; P = .15), and neurodevelopmental impairment was diagnosed in 50.1% of surviving infants in epoch 1 and 58.7% in epoch 2 (OR: 1.4 [95% CI: 0.98–2.04]; P = .07). CONCLUSIONS: Early-childhood outcomes for infants born at <25 weeks' estimated gestational age were unchanged between the 2 periods.

Neurology

Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy

Biological and medical sciences

General aspects

Medical sciences

Nervous system (semeiology, syndromes)

Details

Title: Subtitle: Early-Childhood Neurodevelopmental Outcomes Are Not Improving for Infants Born at <25 Weeks' Gestational Age
Creators: Susan R HINTZ - Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
Douglas E KENDRICK - Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina, United States
Deanne E WILSON-COSTELLO - Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, United States
Abhik DAS - Statistics and Epidemiology Unit, RTI International, Rockville, MD, United States
Edward F BELL - Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States
Betty R VOHR - Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, Rhode Island, United States
Rosemary D HIGGINS - Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States
NICHD Neonatal Research Network
Resource Type: Journal article
Publication Details: Pediatrics (Evanston), Vol.127(1), pp.62-70
DOI: 10.1542/peds.2010-1150
PMID: 21187312
PMCID: PMC3375467
NLM abbreviation: Pediatrics
ISSN: 0031-4005
eISSN: 1098-4275
Publisher: American Academy of Pediatrics
Language: English
Date published: 2011
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984093347702771

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