Download PDF
Am J Perinatol 2024; 41(05): 561-568
DOI: 10.1055/a-1733-2690
Original Article

Neurodevelopmental Outcomes following Preterm Birth and the Association with Postmenstrual Age at Discharge

Polly Kellner
1   Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
,
Jenny Kwon
1   Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
2   Program in Occupational Therapy, Washington University, St. Louis, Missouri
,
Joan Smith
3   Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, Missouri
,
Roberta Pineda 
1   Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
2   Program in Occupational Therapy, Washington University, St. Louis, Missouri
4   Department of Pediatrics, Keck School of Medicine, Los Angeles, California
5   Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California
6   Center for the Changing Family, University of Southern California, Los Angeles, California
› Author Affiliations Funding Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Institute of Health and the Intellectual and Developmental Disabilities Research Center at Washington University (NIH/National Institute of Child Health and Human Development P30 HD062171).
› Further Information
    Permissions and Reprints

Abstract

Objective This study aimed to (1) define the prevalence of motor, cognitive, and language delays in preterm infants born <32 weeks estimated gestational age (EGA); and (2) identify the relationship between the timing of discharge from the neonatal intensive care unit (NICU) and neurodevelopmental outcome in early childhood.

Study Design This retrospective study of 172 preterm infants born <32 weeks EGA and hospitalized in a level-IV NICU captured medical factors, including timing of discharge, from the NICU stay. Standardized developmental testing at 1 to 2 years corrected age was conducted in the newborn follow-up clinic.

Results At 1 to 2 years corrected age, the sample had an average Bayley Scales of Infant and Toddler Development (Bayley-III) cognitive composite score of 91.5 ± 17.4, language composite score of 84.5 ± 17.3, and motor composite score of 88.9 ± 18.4. Lower EGA at birth, necrotizing enterocolitis, patent ductus arteriosus, and oxygen requirement for >28 days were independently associated with higher postmenstrual age (PMA) at NICU discharge. Higher PMA at discharge was associated with poorer cognitive outcome [p < 0.001, β = −1.1 (−1.6, −0.7)], poorer language outcome [p = 0.049, β = −0.5 (−0.9, −0.003)], and poorer motor outcome [p <0.001, β = −1.0 (−1.5, −0.5)]. For every additional week of hospitalization, scores were an average of 1.1 points lower in cognitive, 1.0 point lower in motor, and 0.5 points lower in language domains of the Bayley-III assessment.

Conclusion Poorer cognitive, language, and motor outcomes were associated with longer hospitalization, even after controlling for medical risk factors known to be associated with poorer outcome. This provides further evidence for the potential role of the environment in impacting developmental outcomes of infants hospitalized in the NICU.

Key Points

  • There are high rates of developmental impairment among preterm infants born <32 weeks at 1 year to 2 years.

  • The longer the infant is exposed to the NICU environment, the higher the risk of neurodevelopmental challenges.

  • These findings provide increased motivation for optimizing the early NICU environment.

Keywords

hospitalization - neonatal intensive care unit - length of stay - postmenstrual age - outcomes - child development - risk factors - environment


Publication History

Received: 22 October 2021

Accepted: 03 January 2022

Accepted Manuscript online:
07 January 2022

Article published online:
21 February 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Rathbone R, Counsell SJ, Kapellou O. et al. Perinatal cortical growth and childhood neurocognitive abilities. Neurology 2011; 77 (16) 1510-1517
    Google Scholar
  • 2 Xiong T, Gonzalez F, Mu DZ. An overview of risk factors for poor neurodevelopmental outcome associated with prematurity. World J Pediatr 2012; 8 (04) 293-300
    Google Scholar
  • 3 Badr LK, Bookheimer S, Purdy I, Deeb M. Predictors of neurodevelopmental outcome for preterm infants with brain injury: MRI, medical and environmental factors. Early Hum Dev 2009; 85 (05) 279-284
    Google Scholar
  • 4 Latal B. Prediction of neurodevelopmental outcome after preterm birth. Pediatr Neurol 2009; 40 (06) 413-419
    Google Scholar
  • 5 Marlow N, Wolke D, Bracewell MA, Samara M. EPICure Study Group. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 2005; 352 (01) 9-19
    Google Scholar
  • 6 Stoll BJ, Hansen NI, Adams-Chapman I. et al; National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004; 292 (19) 2357-2365
    Google Scholar
  • 7 Vohr B, McGowan E, McKinley L, Tucker R, Keszler L, Alksninis B. Differential effects of the single-family room neonatal intensive care unit on 18- to 24-month Bayley scores of preterm infants. J Pediatr 2017; 185: 42-48.e1
    Google Scholar
  • 8 Pineda R, Durant P, Mathur A, Inder T, Wallendorf M, Schlaggar BL. Auditory exposure in the neonatal intensive care unit: room type and other predictors. J Pediatr 2017; 183: 56-66.e3
    Google Scholar
  • 9 Institute of Medicine (US) Committee on Understanding Premature Birth and Assuring Healthy Outcomes.. Behrman RE, Butler AS. eds. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: National Academies Press (US); 2007
    Google Scholar
  • 10 Cheong JLY, Burnett AC, Treyvaud K, Spittle AJ. Early environment and long-term outcomes of preterm infants. J Neural Transm (Vienna) 2020; 127 (01) 1-8
    Google Scholar
  • 11 Pineda RG, Neil J, Dierker D. et al. Alterations in brain structure and neurodevelopmental outcome in preterm infants hospitalized in different neonatal intensive care unit environments. J Pediatr 2014; 164 (01) 52-60.e2
    Google Scholar
  • 12 Caskey M, Stephens B, Tucker R, Vohr B. Adult talk in the NICU with preterm infants and developmental outcomes. Pediatrics 2014; 133 (03) e578-e584
    Google Scholar
  • 13 Als H, Duffy FH, McAnulty GB. et al. Early experience alters brain function and structure. Pediatrics 2004; 113 (04) 846-857
    Google Scholar
  • 14 Vittner D, Butler S, Smith K. et al. Parent engagement correlates with parent and preterm infant oxytocin release during skin-to-skin contact. Adv Neonatal Care 2019; 19 (01) 73-79
    Google Scholar
  • 15 Pineda R, Bender J, Hall B, Shabosky L, Annecca A, Smith J. Parent participation in the neonatal intensive care unit: Predictors and relationships to neurobehavior and developmental outcomes. Early Hum Dev 2018; 117: 32-38
    Google Scholar
  • 16 Reynolds LC, Duncan MM, Smith GC. et al. Parental presence and holding in the neonatal intensive care unit and associations with early neurobehavior. J Perinatol 2013; 33 (08) 636-641
    Google Scholar
  • 17 Klawetter S, Greenfield JC, Speer SR, Brown K, Hwang SS. An integrative review: maternal engagement in the neonatal intensive care unit and health outcomes for U.S.-born preterm infants and their parents. AIMS Public Health 2019; 6 (02) 160-183
    Google Scholar
  • 18 Saxton SN, Walker BL, Dukhovny D. Parents matter: examination of family presence in the neonatal intensive care unit. Am J Perinatol 2021; 38 (10) 1023-1030
    Google Scholar
  • 19 Maier RF, Blondel B, Piedvache A. et al; MOSAIC and EPICE Research Groups. Duration and time trends in hospital stay for very preterm infants differ across european regions. Pediatr Crit Care Med 2018; 19 (12) 1153-1161
    Google Scholar
  • 20 Hintz SR, Bann CM, Ambalavanan N, Cotten CM, Das A, Higgins RD. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Predicting time to hospital discharge for extremely preterm infants. Pediatrics 2010; 125 (01) e146-e154
    Google Scholar
  • 21 Eichenwald EC, Blackwell M, Lloyd JS, Tran T, Wilker RE, Richardson DK. Inter-neonatal intensive care unit variation in discharge timing: influence of apnea and feeding management. Pediatrics 2001; 108 (04) 928-933
    Google Scholar
  • 22 Lee HC, Bennett MV, Schulman J, Gould JB. Accounting for variation in length of NICU stay for extremely low birth weight infants. J Perinatol 2013; 33 (11) 872-876
    Google Scholar
  • 23 Gilbert WM, Nesbitt TS, Danielsen B. The cost of prematurity: quantification by gestational age and birth weight. Obstet Gynecol 2003; 102 (03) 488-492
    Google Scholar
  • 24 Bayley N. Bayley Scales of Infant and Toddler Development. 3rd ed.. 2005. San Antonio, TX: Harcourt Assessment, Inc;
    Google Scholar
  • 25 Pickler RH, Best AM, Reyna BA, Wetzel PA, Gutcher GR. Prediction of feeding performance in preterm infants. Newborn Infant Nurs Rev 2005; 5 (03) 116-123
    Google Scholar
  • 26 Balasundaram P, Avulakunta ID. Bayley Scales of Infant and Toddler Development. In: StatPearls. Treasure Island, FL: Statpearls; 2021
    Google Scholar
  • 27 Greene MM, Patra K, Nelson MN, Silvestri JM. Evaluating preterm infants with the Bayley-III: patterns and correlates of development. Res Dev Disabil 2012; 33 (06) 1948-1956
    Google Scholar
  • 28 Kenyhercz F, Nagy BE. A new perspective: Establishing developmental profiles of premature infants based on Bayley-III scores at age 2. Appl Neuropsychol Child 2020; 11 (02) 125-132
    Google Scholar
  • 29 Vandormael C, Schoenhals L, Hüppi PS, Filippa M, Borradori Tolsa C. Language in preterm born children: atypical development and effects of early interventions on neuroplasticity. Neural Plast 2019; 2019: 6873270
    Google Scholar
  • 30 D'Souza D, D'Souza H, Karmiloff-Smith A. Precursors to language development in typically and atypically developing infants and toddlers: the importance of embracing complexity. J Child Lang 2017; 44 (03) 591-627
    Google Scholar
  • 31 Velikos K, Soubasi V, Michalettou I. et al. Bayley-III scales at 12 months of corrected age in preterm infants: patterns of developmental performance and correlations to environmental and biological influences. Res Dev Disabil 2015; 45-46: 110-119
    Google Scholar
  • 32 Pineda R, Raney M, Smith J. Supporting and enhancing NICU sensory experiences (SENSE): defining developmentally-appropriate sensory exposures for high-risk infants. Early Hum Dev 2019; 133: 29-35
    Google Scholar
  • 33 Khurana S, Kane AE, Brown SE, Tarver T, Dusing SC. Effect of neonatal therapy on the motor, cognitive, and behavioral development of infants born preterm: a systematic review. Dev Med Child Neurol 2020; 62 (06) 684-692
    Google Scholar