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      Neurodevelopmental outcomes following late and moderate prematurity: a population-based cohort study

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          Abstract

          Objective

          There is a paucity of data relating to neurodevelopmental outcomes in infants born late and moderately preterm (LMPT; 32 +0–36 +6 weeks). This paper present the results of a prospective, population-based study of 2-year outcomes following LMPT birth.

          Design

          1130 LMPT and 1255 term-born children were recruited at birth. At 2 years corrected age, parents completed a questionnaire to assess neurosensory (vision, hearing, motor) impairments and the Parent Report of Children's Abilities-Revised to identify cognitive impairment. Relative risks for adverse outcomes were adjusted for sex, socio-economic status and small for gestational age, and weighted to account for over-sampling of term-born multiples. Risk factors for cognitive impairment were explored using multivariable analyses.

          Results

          Parents of 638 (57%) LMPT infants and 765 (62%) controls completed questionnaires. Among LMPT infants, 1.6% had neurosensory impairment compared with 0.3% of controls (RR 4.89, 95% CI 1.07 to 22.25). Cognitive impairments were the most common adverse outcome: LMPT 6.3%; controls 2.4% (RR 2.09, 95% CI 1.19 to 3.64). LMPT infants were at twice the risk for neurodevelopmental disability (RR 2.19, 95% CI 1.27 to 3.75). Independent risk factors for cognitive impairment in LMPT infants were male sex, socio-economic disadvantage, non-white ethnicity, preeclampsia and not receiving breast milk at discharge.

          Conclusions

          Compared with term-born peers, LMPT infants are at double the risk for neurodevelopmental disability at 2 years of age, with the majority of impairments observed in the cognitive domain. Male sex, socio-economic disadvantage and preeclampsia are independent predictors of low cognitive scores following LMPT birth.

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          Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study

          Elaine M Boyle, Gry Poulsen, David J Field … (2012)
          Objective To investigate the burden of later disease associated with moderate/late preterm (32-36 weeks) and early term (37-38 weeks) birth. Design Secondary analysis of data from the Millennium Cohort Study (MCS). Setting Longitudinal study of infants born in the United Kingdom between 2000 and 2002. Participants 18 818 infants participated in the MCS. Effects of gestational age at birth on health outcomes at 3 (n=14 273) and 5 years (n=14 056) of age were analysed. Main outcome measures Growth, hospital admissions, longstanding illness/disability, wheezing/asthma, use of prescribed drugs, and parental rating of their children’s health. Results Measures of general health, hospital admissions, and longstanding illness showed a gradient of increasing risk of poorer outcome with decreasing gestation, suggesting a “dose-response” effect of prematurity. The greatest contribution to disease burden at 3 and 5 years was in children born late/moderate preterm or early term. Population attributable fractions for having at least three hospital admissions between 9 months and 5 years were 5.7% (95% confidence interval 2.0% to 10.0%) for birth at 32-36 weeks and 7.2% (1.4% to 13.6%) for birth at 37-38 weeks, compared with 3.8% (1.3% to 6.5%) for children born very preterm (<32 weeks). Similarly, 2.7% (1.1% to 4.3%), 5.4% (2.4% to 8.6%), and 5.4% (0.7% to 10.5%) of limiting longstanding illness at 5 years were attributed to very preterm birth, moderate/late preterm birth, and early term birth. Conclusions These results suggest that health outcomes of moderate/late preterm and early term babies are worse than those of full term babies. Additional research should quantify how much of the effect is due to maternal/fetal complications rather than prematurity itself. Irrespective of the reason for preterm birth, large numbers of these babies present a greater burden on public health services than very preterm babies.
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            Late gestation cerebellar growth is rapid and impeded by premature birth.

            Catherine Limperopoulos, Janet S Soul, Kimberlee Gauvreau … (2005)
            Cognitive impairments and academic failure are commonly reported in survivors of preterm birth. Recent studies suggest an important role for the cerebellum in the development of cognitive and social functions. The objective of this study was to examine the impact of prematurity itself, as well as prematurity-related brain injuries, on early postnatal cerebellar growth with quantitative MRI. Advanced 3-dimensional volumetric MRI was performed and cerebellar volumes were obtained by manual outlining in preterm (<37 weeks) and healthy term-born infants. Intracranial and total brain volumes were also calculated. A total of 169 preterm and 20 healthy full-term infants were studied; 145 had preterm MRI (pMRI), 75 had term MRI (tMRI), and 51 underwent both pMRI and tMRI. From 28 weeks' postconceptional age to term, mean cerebellar volume (177%) in preterm infants increased at a much faster rate than did mean intracranial (110%) or mean brain (107%) volumes. Smaller cerebellar volume was significantly related to lower gestational age at birth and to intracranial and total brain volumes. Mean cerebellar volume of preterm infants at tMRI was significantly smaller than the volumes of term-born infants. Cerebellar growth impairment was correlated strongly with associated brain injuries, even in the absence of direct cerebellar injury. Our data suggest that the growth of the immature cerebellum is particularly rapid during late gestation. However, this accelerated growth seems to be impeded by premature birth and associated brain injury. The long-term neurodevelopmental disabilities seen in survivors of premature birth may be attributable in part to impaired cerebellar development.
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              Epidemiology of late and moderate preterm birth.

              Carrie K Shapiro-Mendoza, Eve Lackritz (2012)
              Preterm birth affects 12.5% of all births in the USA. Infants of Black mothers are disproportionately affected, with 1.5 times the risk of preterm birth and 3.4 times the risk of preterm-related mortality. The preterm birth rate has increased by 33% in the last 25 years, almost entirely due to the rise in late preterm births (34-36 weeks' gestation). Recently attention has been given to uncovering the often subtle morbidity and mortality risks associated with moderate (32-33 weeks' gestation) and late preterm delivery, including respiratory, infectious, and neurocognitive complications and infant mortality. This section summarizes the epidemiology of moderate and late preterm birth, case definitions, risk factors, recent trends, and the emerging body of knowledge of morbidity and mortality associated with moderate and late preterm birth. Published by Elsevier Ltd.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Dis Child Fetal Neonatal Ed
                Journal ID (iso-abbrev): Arch. Dis. Child. Fetal Neonatal Ed
                Journal ID (hwp): fetalneonatal
                Journal ID (publisher-id): fnn
                Title: Archives of Disease in Childhood. Fetal and Neonatal Edition
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Print): 1359-2998
                ISSN (Electronic): 1468-2052
                Publication date (Print): July 2015
                Publication date (Electronic): 1 April 2015
                Volume: 100
                Issue: 4
                Pages: F301-F308
                Affiliations
                [1 ]Department of Health Sciences, University of Leicester , Leicester, UK
                [2 ]Department of Academic Neonatology, Institute for Women's Health, University College London , London, UK
                [3 ]Division of Health Sciences, Warwick Medical School, University of Warwick , Coventry, UK
                Author notes
                [Correspondence to ] Dr Samantha Johnson, Department of Health Sciences, University of Leicester, 22–28 Princess Road West, Leicester LE1 6TP, UK; sjj19@ 123456le.ac.uk .
                Article
                Publisher ID: fetalneonatal-2014-307684
                DOI: 10.1136/archdischild-2014-307684
                PMC ID: 4484499
                PubMed ID: 25834170
                SO-VID: adb57614-13d8-414e-9920-45444871e0b6
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
                License:

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                Date received : 9 October 2014
                Date revision received : 12 December 2014
                Date accepted : 1 January 2015
                Categories
                Subject: 1506
                Subject: Original Article
                Custom metadata
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                ScienceOpen disciplines: Neonatology
                Keywords: neurodevelopment,neonatology
                Data availability:
                ScienceOpen disciplines: Neonatology
                Keywords: neurodevelopment, neonatology

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