Article | Published:

Factors affecting neurodevelopmental outcome at 2 years in very preterm infants below 1250 grams: a prospective study

Journal of Perinatologyvolume 38pages10931100 (2018) | Download Citation

Abstract

Objective

To evaluate the neurodevelopmental outcomes of preterm very-low birth weight (PT/VLBW) infants at 2 years and identify risk factors associated with significant developmental delay or neurodevelopmental impairment (NDI).

Study design

We evaluated 165 PT/VLBW infants born between January 2010 and December 2011, using the Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III). NDI was defined as the presence of neurosensory impairment or significant delay with Bayley-III score < 70 in any domain and risk factors for delay/NDI were assessed using logistic regressions.

Results

Median Bayley-III composite scores in the cognitive, language and motor domains were 95, 89 and 94, respectively. NDI was present in 20% of the children, with 5–18% having significant delay in either cognitive, language or motor domain, seven (4%) children had cerebral palsy, three (2%) were deaf and none were blind. Regression models identified significant positive associations of delayed cognitive skills with male gender (Odds ratio (OR) 22.4, 95% confidence interval (CI) 1.5–341.1; P = 0.025), lack of anntenatal steroids (ANS) (OR 41.5, 95% CI 3.5–485.7; P = 0.003), and hypotension needing inotropes (OR 36.0, 95% CI 2.6–506.0; P = 0.008); delayed language skills with lower maternal education (OR 3.8, 95% CI 1.4–10.3; P = 0.10), lack of ANS (OR 2.8, 95% CI 1.1–7.4; P = 0.04), and 5 minute Apgar Score ≤ 5 (OR 7.4, 95% CI 1.4–38.4; P = 0.017) and delayed motor skills with chronic lung disease at 36 weeks (OR 38.3, 95% CI 2.4–603.4; P = 0.010). NDI was associated with lack of ANS (OR 2.91, 95% CI 1.21–7.00; P = 0.02) and use of postnatal steroids (OR 3.36, 95% CI 1.07–10.54; P = 0.0374).

Conclusion

Risk factors for both NDI and individual domain delay were identified and will be helpful in planning of specific and targeted early intervention services.

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Author information

Affiliations

  1. Department of Child Development, KK Women’s and Children’s Hospital, Singapore, Singapore

    • Pratibha Keshav Agarwal
    • , Phey Hong Yang
    •  & Lourdes Mary Daniel
  2. Department of Epidemiology, Singapore Clinical Research Institute, Singapore, Singapore

    • Luming Shi
    •  & Qishi Zheng
  3. Duke-NUS Medical School, Singapore, Singapore

    • Luming Shi
    • , Victor Samuel Rajadurai
    • , Poh Choo Khoo
    • , Bin Huey Quek
    •  & Lourdes Mary Daniel
  4. Cochrane Singapore, Singapore, Singapore

    • Luming Shi
    •  & Qishi Zheng
  5. Department of Neonatology, KK Women’s and Children’s Hospital, Singapore, Singapore

    • Victor Samuel Rajadurai
    •  & Bin Huey Quek
  6. Department of Psychology, National University of Singapore, Singapore, Singapore

    • Phey Hong Yang

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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Qishi Zheng.

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DOI

https://doi.org/10.1038/s41372-018-0138-3