Neurodevelopment at 2 years corrected age among Vietnamese preterm infants

Abstract

Background: Preterm infants are at risk of neurodevelopmental delay, but data on long-term outcomes in low-income and middle-income countries remain scarce.

Objectives: To examine neurodevelopment using Bayley Scales of Infant and Toddler Development-3rd edition (Bayley-III) and neurological findings in 2-year-old preterm infants, and to compare with healthy Vietnamese infants. Further, to assess factors associated with neurodevelopmental impairment.

Design and setting: Cohort study to follow up preterm infants discharged from a neonatal intensive care unit (NICU) of a tertiary children's hospital in Vietnam.

Participants: Infants born at <37 weeks of gestational age.

Main outcomes: Bayley-III assessment and neurological examination at 2-year corrected age (CA) compared with healthy Vietnamese infants.

Results: Of 294 NICU preterm infants, Bayley-III scores of all 184/243 (76%) survivors at 2 years CA were significantly lower than those of healthy Vietnamese peers in all three domains: cognition (mean (SD): 84.5 (8.6) vs 91.4 (7.5), p<0.001), language (mean (SD): 88.7 (12.5) vs 95.9 (11.9), p<0.001) and motor (mean (SD): 93.1 (9.0) vs 96.8 (9.3), p=0.003). The mean differences in Bayley-III scores between preterm and healthy Vietnamese infants were -6.9 (-9.1 to -4.7), -7.2 (-10.5 to -3.8) and -3.7 (-6.1 to -1.2) for cognitive, language and motor scores, respectively. The prevalence of neurodevelopmental impairment was 17% for cognitive, 8% for language and 4% for motor performance. In total, 7% were diagnosed with cerebral palsy. Higher maternal education was positively associated with infant neurodevelopment (OR 0.32, 95% CI 0.11 to 0.94).

Conclusions: Vietnamese preterm infants in need of neonatal intensive care showed poor neurodevelopment at 2 years. Higher maternal education was positively associated with infant neurodevelopment. Standard follow-up programmes for preterm infants should be considered in low-resource settings.

Keywords: Bayley scale; intensive care; low resource setting; middle-income country; neurodevelopment; preterm infant.

Figure 1

Flow chart of preterm infants from NICU discharge to 24-month neurodevelopmental assessment. NICU, neonatal intensive care unit. CA, corrected age. *Reasons for attrition (number of infants): being unable to contact (25), travel problems (11), language of minor ethnics (3), living abroad (3), well-being child (5) and unspecified (12).

Figure 2

Adjusted risk factors for any neurodevelopmental impairment.* (OR and 95% CI). *Any neurodevelopmental impairment is defined as a Bayley-III score on any composite score <−1 SD or GMFCS level ≥1 or any neurological abnormality. †OR estimated as follows: for gender, girl relative to boy; for gestational age, increment in each week of gestation; for mechanical ventilation, at least 1 day treated with ventilator relative to non-ventilator; for neonatal surgery, at least one surgery relative to non-surgery; for maternal age, increment in each year of age; for maternal education, low maternal education used as reference for moderate and high maternal education. ‡P value <0.05.