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Risk Assessment of Cognitive Impairment at 2 Years of Age in Infants Born Extremely Preterm Using the INTERGROWTH-21st Growth Standards
Journal article   Peer reviewed

Risk Assessment of Cognitive Impairment at 2 Years of Age in Infants Born Extremely Preterm Using the INTERGROWTH-21st Growth Standards

Ariel A. Salas, Waldemar A. Carlo, Carla M. Bann, Edward F. Bell, Tarah T. Colaizy, Noelle Younge, Myriam Peralta, Namasivayam Ambalavanan, Brenda B. Poindexter and Eunice Kennedy Shriver NICHD Neonatal Research Network
The Journal of pediatrics, Vol.275, 114239
08/19/2024
DOI: 10.1016/j.jpeds.2024.114239
PMCID: PMC11560614
PMID: 39168179
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC11560614/pdf/nihms-2019944.pdfView
Open Access

Abstract

To assess the risk of cognitive impairment among infants born extremely preterm using the INTERGROWTH-21st standards. We analyzed anthropometric data at birth and 36 weeks postmenstrual age (PMA) from infants born extremely preterm (24 to 26 weeks of gestation) admitted to US neonatal units between 2008 and 2018. To determine INTERGROWTH-21st z-score values that indicate an increased risk of cognitive impairment at 2 years of age (Bayley cognitive score < 85), we employed classification and regression trees (CART) and redefined growth failure (weight, length, and head circumference z-scores at 36 weeks PMA) and growth faltering (weight, length, and head circumference z-score declines from birth to 36 weeks PMA). Among 5,393 infants with a mean gestational age of 25 weeks, growth failure defined as a weight z-score of -1.8 or below at 36 weeks PMA and growth faltering defined as a weight z-score decline of 1.1 or greater from birth to 36 weeks PMA indicated a higher likelihood of cognitive impairment. A length z-score less than -1 at 36 weeks PMA had the highest sensitivity to detect cognitive impairment at 2 years (80%). A head circumference z-score decline of 2.43 or greater from birth to 36 weeks PMA had the highest specificity (86%). Standard definitions had fair to low sensitivity and specificity for risk detection of cognitive impairment. Length and head circumference z-scores had the highest sensitivity and specificity for risk detection of cognitive impairment. Monitoring these growth parameters could guide earlier individualized interventions with potential to reduce cognitive impairment.
NDI CCS PMA CART

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