Neurodevelopmental outcomes of extremely low birth weight infants <32 weeks’ gestation between 1993 and 1998. Pediatrics

Women & Infants Hospital, Providence, Rhode Island, United States
PEDIATRICS (Impact Factor: 5.47). 10/2005; 116(3):635-43. DOI: 10.1542/peds.2004-2247
Source: PubMed

ABSTRACT This study evaluated the impact of changes in perinatal management on neurodevelopmental impairment (NDI) at 18 to 22 months' corrected age of low gestation (22-26 weeks) and higher gestation (27-32 weeks) extremely low birth weight infants (401-1000 g birth weight) who were cared for in the National Institute of Child Health and Human Development Neonatal Research Network during 3 epochs (1993-1994, 1995-1996, and 1997-1998). It was hypothesized that outcomes would improve over the 3 epochs.
A multicenter cohort study was conducted of the outcomes of 3785 infants with assessments at 18 to 22 months' corrected age. Regression analyses were completed to evaluate for epoch effects, gestational age effects, and time plus gestational age interaction. Regression analyses were also performed to identify the independent associations of epoch and 4 study perinatal interventions: antenatal steroids (yes, no), high-frequency ventilation (yes, no), number of days to regain birth weight as a marker of nutritional intake, and postnatal steroids for treatment of bronchopulmonary dysplasia (yes, no) with outcomes.
Survival improved for both the low (55%-61%) and higher (82%-86%) gestational age groups during the 3 epochs. Regression analyses indicated that the decreased risk for adverse outcome was significantly lower in epoch 2 compared with epoch 1 with decreased rates of low Bayley Mental Development Index (MDI) and neurodevelopmental impairment (NDI). Antenatal steroids were associated with decreased risk for moderate to severe cerebral palsy (CP) and low Bayley Psychomotor Development Index. High-frequency ventilation was associated with a low Bayley MDI and NDI, and postnatal steroids were associated with moderate to severe CP, any CP, low Bayley MDI, low Bayley Psychomotor Development Index, and increased NDI.
Survival of extremely low birth weight infants improved between 1993 and 1998. Although some outcomes remained unchanged, the rates of low Bayley MDI scores and NDI improved. Antenatal steroid administration was the only study intervention associated with improved outcomes.

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    • "Although the survival of very preterm infants has increased significantly during recent decades (Vohr et al., 2005), many of these infants still develop with neurological impairments. Neonatal neurological examination is challenged by the non-specificity of signs of neural dysfunction (discussed above) and, consequently, complementary biomarkers for adverse outcome have been sought from neuroimaging and neurophysiology. "
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    ABSTRACT: The mysteries of early development of cortical processing in humans have started to unravel with the help of new non-invasive brain research tools like multichannel magnetoencephalography (MEG). In this review, we evaluate, within a wider neuroscientific and clinical context, the value of MEG in studying normal and disturbed functional development of the human somatosensory system. The combination of excellent temporal resolution and good localization accuracy provided by MEG has, in the case of somatosensory studies, enabled the differentiation of activation patterns from the newborn's primary (SI) and secondary somatosensory (SII) areas. Furthermore, MEG has shown that the functioning of both SI and SII in newborns has particular immature features in comparison with adults. In extremely preterm infants, the neonatal MEG response from SII also seems to potentially predict developmental outcome: those lacking SII responses at term show worse motor performance at age 2 years than those with normal SII responses at term. In older children with unilateral early brain lesions, bilateral alterations in somatosensory cortical activation detected in MEG imply that the impact of a localized insult may have an unexpectedly wide effect on cortical somatosensory networks. The achievements over the last decade show that MEG provides a unique approach for studying the development of the somatosensory system and its disturbances in childhood. MEG well complements other neuroimaging methods in studies of cortical processes in the developing brain.
    Frontiers in Human Neuroscience 03/2014; 8:158. DOI:10.3389/fnhum.2014.00158 · 2.99 Impact Factor
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    • "It is unclear, however, whether multiple births are at increased risk for neurologic impairment compared with birth weight–matched singletons. Some reports indicated a higher rate of neurodevelopmental impairments for preterm multiple births [56], but others did not [92]. "
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