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Multicenter Study
. 2011 Jan;127(1):62-70.
doi: 10.1542/peds.2010-1150. Epub 2010 Dec 27.

Early-childhood neurodevelopmental outcomes are not improving for infants born at <25 weeks' gestational age

Susan R Hintz  1 , Douglas E Kendrick, Deanne E Wilson-Costello, Abhik Das, Edward F Bell, Betty R Vohr, Rosemary D Higgins; NICHD Neonatal Research Network
Collaborators, Affiliations
Multicenter Study

Early-childhood neurodevelopmental outcomes are not improving for infants born at <25 weeks' gestational age

Susan R Hintz et al. Pediatrics. 2011 Jan.

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.

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Figures

FIGURE 1
FIGURE 1
Progression of patients in epochs 1 and 2 from survival to neurodevelopmental follow-up. Epoch 1: born January 1, 1999, to December 31, 2001; epoch 2: born January 1, 2002, to December 31, 2004.
See this image and copyright information in PMC

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