Long-term neurodevelopmental outcome of preterm infants: Management
- Deanne Wilson-Costello, MD
Deanne Wilson-Costello, MD
- Professor of Pediatrics
- Director of High Risk Follow-up
- Rainbow Babies and Children's Hospital
- Allison Payne, MD MS
Allison Payne, MD MS
- Professor, Department of Pediatrics, Neonatology
- Case Western Reserve University
- Section Editors
- Richard Martin, MD
Richard Martin, MD
- Section Editor — Neonatology
- Professor, Pediatrics, Reproductive Biology, and Physiology & Biophysics
- Case Western Reserve University School of Medicine
- Marilyn Augustyn, MD
Marilyn Augustyn, MD
- Section Editor — Developmental and Behavioral Pediatrics
- Associate Professor
- Boston University School of Medicine
Neurodevelopmental impairment is a major long-term complication for many former preterm infants. However, comprehensive ongoing assessment to detect neurodevelopmental sequelae and early interventions services are costly and labor intensive and may not be warranted in all preterm survivors. As a result, a key management issue confronting clinicians who care for preterm survivors and their families is identifying infants who are at risk for subsequent significant neurodevelopmental disability and who may benefit from early intervention. This is particularly challenging as available screening tools are not precise enough for accurate prediction of neurodevelopmental outcome for individual patients.
This topic will discuss follow-up neurodevelopmental care of former preterm infants recognizing the challenge of accurate clinical prediction. The epidemiology and risk factors of neurodevelopmental impairment for preterm infants are discussed separately. (See "Long-term neurodevelopmental outcome of preterm infants: Epidemiology and risk factors".)
Prematurity — Degrees of preterm birth are typically defined by gestational age (GA) or birth weight (BW). The following definitions are used throughout this review.
The classification based upon GA is as follows:
●Late preterm birth – GA between 34 weeks and 36 6/7 weeks
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- Neurodevelopmental outcome
- CHALLENGES IN PREDICTING OUTCOME
- - Ultrasonography
- - Magnetic resonance imaging (MRI)
- MRI at term gestation
- MRI during childhood, adolescence, and adulthood
- - Our approach
- Electroencephalography: Unproven tool
- Timing of clinical assessment
- APPROACH FOR FOLLOW-UP CARE
- Follow-up neurodevelopmental care based on risk assessment
- Initial outpatient visit
- Infants ≥30 weeks gestation without additional risk factors
- Infants <30 weeks gestation and/or with risk factors
- - Neurologic assessment
- Cerebral palsy
- - Hearing
- - Vision
- - Cognitive and motor assessment
- Early intervention programs
- - United States
- SUMMARY AND RECOMMENDATIONS