Correlation discovered between neonatal and early childhood outcomes among children delivered preterm
In a study to be presented on Feb. 6 at 3:15 p.m. CST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in New Orleans, researchers will report on a correlation between initial neonatal and early childhood outcomes among children delivered less than 34 weeks gestation.
Preterm babies are at high risk for death and other serious medical complications, and some premature infants continue to experience side effects from prematurity even during later childhood. It’s uncertain whether preterm babies diagnosed with intestinal problems, severe respiratory problems, bleeding in their brains, and other complications during their stay in the newborn intensive care unit (NICU) after birth will continue to have complications when examined later in childhood.
This study examined more than 1,700 babies who were born prematurely at less than 34 weeks gestation. It then followed babies after they were discharged from the NICU and re-evaluated them as 2-year-olds for evidence of cerebral palsy and neurologic impairment.
Results revealed that about one in five babies who appeared healthy at the time of hospital discharge had cerebral palsy or neurologic impairment at 2 years of age. Further, one in three babies who had one or more serious complications during their NICU stay also had these complications.
“Babies delivered preterm are at high risk for complications as newborns and also later in childhood,” said Tracy Manuck, M.D., one of the researchers and co-director of the University of Utah Prematurity Prevention Clinic. “We found that babies who had serious complications in the newborn intensive care unit were more likely to have cerebral palsy or neurologic impairment in early childhood, but not necessarily. The converse is also true, as about one in five babies who appeared healthy at the time of hospital discharge had complications in early childhood. Early childhood evaluation and interventions should not be withheld from seemingly healthy previous preterm children.”
However, Manuck noted that the relationship between serious NICU complications and serious neurologic impairment in early childhood was not perfect, as the NICU complications were only moderately predictive of prognosis later in childhood.
Abstract 35: Correlation Between Initial Neonatal and Early Childhood Outcomes Among Children Delivered <34 Weeks Gestation
Authors: Tracy Manuck1, Xiaoming Sheng2, Bradley Yoder2, Michael Varner1
1University of Utah, Obstetrics and Gynecology, Salt Lake City, UT, 2University of Utah, Pediatrics, Salt Lake City, UT
Objective: Obstetric researchers commonly use neonatal morbidities as surrogate endpoints for longer-term outcomes. We sought to correlate neonatal diagnoses prior to hospital discharge with early childhood cognitive and motor function.
Study Design: Secondary analysis of a multicenter RCT of antenatal magnesium sulfate (Mg) vs. placebo administered to women at imminent risk for early PTB to prevent death and cerebral palsy (CP) in their offspring. All women were at high risk for PTB <32.0 wks. Singletons delivered 24.0-33.9 wks who survived to hospital discharge post-birth and had 2-year-old outcome data were included. Those surviving to age 2 were assessed by trained physicians and Bayley Scales of Infant Development Mental Development and Psychomotor Development Indices (MDI, PDI). Neonatal diagnoses at each baby’s initial hospital discharge were examined singly and in combination to determine those most predictive of severe composite childhood morbidity, defined as a childhood diagnosis of moderate/severe CP and/or Bayley MDI and/or PDI scores >2 SD below the mean. Data were analyzed by multiple logistic regression and area under ROC curves (AUC).
Results: 1400 children met criteria. Children were delivered at a mean of 29.9 (range: 24.0-33.9) wks gestation. 58 (4.1%) had moderate/severe CP. On Bayley testing, 245 (19.2%) had a MDI Score >2 SD and 229 (17.8%) a PDI Score >2SD below the mean. A total of 349 (24.9%) had severe composite childhood morbidity. Multivariable regression results demonstrating the relationship between neonatal diagnoses and severe childhood morbidity are shown in the Table.
Conclusion: Approximately 1 in 4 children born <34 weeks had severe childhood morbidity at age 2. Individual neonatal morbidities (BPD, NEC, sepsis, severe IVH, and PVL) had modest predictive value for subsequent adverse early childhood outcomes; combinations of multiple morbidities were only marginally more prognostic. Prediction of childhood outcomes from neonatal diagnoses remains imperfect.