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Outcome at 3 Years of Age in a Population-Based Cohort of Extremely Preterm Infants

From the ¹Research Group Developmental Disabilities, Ghent University, Ghent, Belgium; ²Department of Neonatology, Ghent University Hospital, Ghent, Belgium; ³Department of Neonatology, Algemeen Ziekenhuis Zuid-Oost Limburg, Genk, Belgium; ⁴Department of Child Neurology, Koningin Paola Kinderziekenhuis, Antwerp, Belgium; ⁵Center for Developmental Disorders Brugge, Brugge, Belgium; ⁶Department of Child Neurology, Brussels University Hospital, Brussels, Belgium; ⁷Department of Neonatology, Antwerp University Hospital, Antwerp, Belgium; ⁸Center for Developmental Disorders Ghent, Ghent, Belgium; ⁹Department of Pediatric Neurology, University Hospital Gasthuisberg, Leuven, Belgium; and ¹⁰Department of Neonatology, Algemeen Ziekenhuis St-Augustinus, Antwerp, Belgium.

ABSTRACT

OBJECTIVE: To assess health and neurodevelopmental outcome at 3 years of age in neonatal intensive care unit (NICU)–surviving children who were born at 26 or fewer weeks of gestation in a geographically defined region of Belgium from 1999 through 2000.

METHODS: The study included a clinical examination and a standardized neurologic and developmental assessment. Disabilities were defined by international criteria. In 97% (92 of 95) of the children, accurate information on the presence of overall disability could be collected.

RESULTS: Thirty-six percent (95% confidence interval [CI] 25–47%) of the formally assessed children (28 of 77) had deficient neuromotor development, with 5% of them showing severe sensory-communicative impairment. Mean (±standard deviation) scores on the Mental Developmental Index and Psychomotor Developmental Index were 81.2 (18.8) and 73.2 (17.8), respectively. Seventy percent (95% CI 60–80%) had a mental (Mental Developmental Index) or psychomotor (Psychomotor Developmental Index) impairment or both, assessed to be more than 1 standard deviation below the population mean. Mental and psychomotor outcome did not differ significantly when compared according to either gestational age, gender, or multiple birth (all P>.05).

When either minor central dysfunction or cerebral palsy was not taken into account, normal mental development was recorded in 62% of the subjects. The cumulative of poor outcome (ie, disability- or prematurity-related death) among the 95 infants discharged alive was estimated to be 58% (95% CI 48–68%), representing 25 (26%) mildly-to-moderately disabled and 28 (29%) severely disabled toddlers, including two infants whose postdischarge deaths were directly related to prematurity.

CONCLUSION: The average developmental outcome is poor in children born as extremely preterm infants. Finding early predictors of adverse outcome is a major challenge.

LEVEL OF EVIDENCE: III