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Z Geburtshilfe Neonatol 2022; 226(06): 405-415
DOI: 10.1055/a-1864-9895
Original Article

Enhancing the Follow-up Assessment of Very Preterm Children with Regard to 5-Year IQ Considering Socioeconomic Status

Optimierung der Nachuntersuchung Frühgeborener im Hinblick auf ihren IQ mit 5 Jahren unter besonderer Berücksichtigung des Sozioökonomischen Status
Kathrin Hoberg 
1   Department of Paediatrics, Social Paediatric Centre, Division of Neuropaediatrics and Social Paediatrics; University Hospital RWTH Aachen, RWTH Aachen University, Aachen, Germany
,
Martin Häusler
2   Department of Paediatrics, Division of Neuropediatrics and Social Pediatrics; University Hospital RWTH Aachen, RWTH Aachen University, Aachen, Germany
,
Thorsten Orlikowsky
3   Department of Paediatrics, Division of Neonatology; University Hospital RWTH Aachen, RWTH Aachen University, Aachen, Germany
,
Karen Lidzba
4   Division of Child Neurology, Department of Pediatrics, Pediatric Neurology, Inselspital University Hospital Bern, Bern, Switzerland
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Abstract

Background Specifying peri- and postnatal factors in children born very preterm (VPT) that affect later outcome helps to improve long-term treatment.

Aim To enhance the predictability of 5-year cognitive outcome by perinatal, 2-year developmental and socio-economic data. Subjects and outcome measures: 92 VPT infants, born 2007–2009, gestational age<32 weeks and/or birthweight of 1500 g, were assessed longitudinally including basic neonatal, socio-economic (SES), 2-year Mental Developmental Index (MDI, Bayley Scales II), 5-year Mental Processing Composite (MPC, Kaufman-Assessment Battery for Children), and Language Screening for Preschoolers data. 5-year infants born VPT were compared to 34 term controls.

Results The IQ of 5-year infants born VPT was 10 points lower than that of term controls and influenced independently by preterm birth and SES. MDI, SES, birth weight and birth complications explained 48% of the variance of the MPC. The MDI proved highly predictive (r=0.6, R2=36%) for MPC but tended to underestimate the cognitive outcome. A total of 61% of the 2-year infants born VPT were already correctly classified (specificity of .93, sensitivity of .54). CHAID decision tree technique identified SES as decisive for the outcome for infants born VPT with medium MDI results (76–91): They benefit from effects associated to a higher SES, while those with a poor MDI outcome and a birth weight≤890 g do not.

Conclusion Developmental follow-up of preterm children enhances the quality of prognosis and later outcome when differentially considering perinatal risks and SES.

Zusammenfassung

Hintergrund Spezifisches Identifizieren peri- und postnataler Faktoren verbessert die langfristige Behandlung sehr frühgeborener (VPT) Kinder und damit ihre Entwicklungschancen.

Ziel Die kognitive Entwicklung 5-jähriger VPT Kinder auf Basis von perinatalen, sozioökonomischen und entwicklungsrelevanten 2-Jahres-Daten optimal vorhersagen. Patienten und Methoden: 92 sehr Frühgeborene, geboren 2007–2009,<32 SSW bzw.<1500 g wurden längsschnittlich untersucht anhand von neonatalen Daten, sozioökonomischem Status (SES), 2-Jahres Mental Developmental Index (MDI, Bayley Scales II), 5-Jahres IQ (MPC, K-ABC) und des Sprachscreenings für Vorschulkinder. Die 5-jährigen VPT Kinder wurden mit 34 gleichaltrigen Reifgeborenen verglichen.

Ergebnisse 5-jährige VPT Kinder hatten einen 10 Punkte niedrigeren IQ als Reifgeborene, separat beeinflusst durch die Faktoren Frühgeburt und SES. MDI; SES, Geburtsgewicht und -komplikationen erklärten 48% der Varianz des MPC. Der MDI erwies sich als starker Prädiktor (r=0.6, R2=36%), 61% der Frühgeborenen wurden bereits mit 2 Jahren richtig eingestuft (Spezifität .93, Sensitivität .54). Ein CHAID Entscheidungsbaum identifizierte den SES als entscheidende Variable bei mittlerem MDI (76–91). Diese VPT Kinder profitieren von einem höheren SES; jene mit schlechtem MDI und einem Geburtsgewicht ≤ 890 g tun dies nicht.

Schlussfolgerung Die differenzierte Berücksichtigung von perinatalen Risikofaktoren und SES verbessert die entwicklungsdiagnostische Nachsorge sehr frühgeborener Kinder in der Qualität der Prognose und damit ein besseres späteres Outcome.

Key words

very preterm - socioeconomic status - birthweight - prediction - cognitive

Schlüsselwörter

Sehr Frühgeborene - Sozioökonomischer Status - Geburtsgewicht - Vorhersage - Kognition

Supplementary Material



Publication History

Received: 15 July 2021

Accepted after revision: 16 May 2022

Article published online:
18 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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