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. 2023 Dec 21;11(1):12.
doi: 10.3390/children11010012.

Neurodevelopmental Outcome and Neuroimaging of Very Low Birth Weight Infants from an Italian NICU Adopting the Family-Centered Care Model

Licia Lugli  1 , Marisa Pugliese  2 , Natascia Bertoncelli  1 , Luca Bedetti  1 , Cristina Agnini  1 , Isotta Guidotti  1 , Maria Federica Roversi  1 , Elisa Muttini Della Casa  1 , Francesca Cavalleri  3 , Alessandra Todeschini  3 , Antonella Di Caprio  4 , Tommaso Zini  1 , Lucia Corso  4 , Francesca Miselli  1   5 , Fabrizio Ferrari  1 , Alberto Berardi  1
Affiliations

Neurodevelopmental Outcome and Neuroimaging of Very Low Birth Weight Infants from an Italian NICU Adopting the Family-Centered Care Model

Licia Lugli et al. Children (Basel). .

Abstract

Background: Improvements in perinatal care have substantially decreased mortality rates among preterm infants, yet their neurodevelopmental outcomes and quality of life persist as a pertinent public health concern. Family-centered care has emerged as a holistic philosophy that promotes effective alliances among patients, families, and healthcare providers to improve the quality of care.

Aims: This longitudinal prospective study aims to evaluate the neurodevelopmental outcomes and brain MRI findings in a cohort of preterm newborns admitted to a neonatal intensive care unit (NICU) adopting a family-centered care model.

Methods: Very low birth weight (VLBW) infants admitted to the NICU of Modena between 2015 and 2020 were enrolled. Infants who underwent conventional brain magnetic resonance imaging (MRI) at term-equivalent age were included. Neurodevelopmental follow-up was performed until the age of 24 months by a multidisciplinary team using the Amiel-Tison neurological assessment and the Griffiths Mental Developmental Scales (GMDS-R). Neurodevelopmental outcomes were classified as major sequelae (cerebral palsy, DQ ≤ 70, severe sensory impairment), minor sequelae (minor neurological signs such as clumsiness or DQ between 71 and 85), and normal outcomes (no neurological signs and DQ > 85). Risk factors for severe outcomes were assessed.

Results: In total, 49 of the 356 infants (13.8%) died before hospital discharge, and 2 were excluded because of congenital disorders. Of the remaining 305 infants, 222 (72.8%) completed the 24 month follow-up and were included in the study. Neurodevelopmental outcomes were classified as normal (n = 173, 77.9%), minor (n = 34, 15.3%), and major sequelae (n = 15, 6.8%). Among 221 infants undergoing brain MRI, 76 (34.4%) had major lesions (intraventricular hemorrhage, hemorrhagic parenchymal infarction, periventricular leukomalacia, and large cerebellar hemorrhage). In the multivariate regression model, the retinopathy of prematurity (OR 1.8; p value 0.016) and periventricular-intraventricular hemorrhage (OR 5.6; p value < 0.004) were associated with major sequelae.

Conclusions: We reported low rates of severe neurodevelopmental outcomes in VLBW infants born in an Italian NICU with FCC. Identifying the risk factors for severe outcomes can assist in tailoring and optimizing early interventions on an individual basis, both within the NICU and after discharge.

Keywords: brain magnetic resonance imaging; neurodevelopmental outcomes; preterm infants; very low birth weight.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Mortality rate in relation to gestational age at birth.
Figure 3
Figure 3
Severe neurodevelopmental outcomes in relation to gestational age at birth.
Figure 4
Figure 4
Developmental profile of the study population according to neurodevelopmental outcomes at 24 months of corrected age *. * Mean values of Griffiths Mental Development Quotient and subscales are reported. Hearing–Language scale was significantly lower than other scales in all groups (p < 0.01).
Figure 5
Figure 5
Hearing and Language Griffiths Mental Development subscale in infants without major sequelae.
Figure 6
Figure 6
Microcystic periventricular leukomalacia in a patient with severe outcomes. White matter reduction with ventricular dilatation and microcysts near the right lateral ventricle (arrows).
Figure 7
Figure 7
Macrocystic periventricular leukomalacia in patients with severe outcomes. White matter reduction with left ventricular dilatation (blue arrow) and bilateral periventricular macrocysts (red arrows).
Figure 8
Figure 8
Ventricular dilatation with ex vacuo severe dilatation of the right ventricle frontal horn following intraventricular hemorrhage (IVH) and right hemorrhagic parenchymal infarction (HPI), in a patient with severe outcome.
Figure 9
Figure 9
Abnormal myelin. White matter hyperintensity (arrows) in a patient with minor sequelae.
See this image and copyright information in PMC

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