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
- O'Shea TM, Kuban KC, Allred EN, et al. Neonatal cranial ultrasound lesions and developmental delays at 2 years of age among extremely low gestational age children. Pediatrics 2008; 122:e662.
- Bassan H, Limperopoulos C, Visconti K, et al. Neurodevelopmental outcome in survivors of periventricular hemorrhagic infarction. Pediatrics 2007; 120:785.
- Payne AH, Hintz SR, Hibbs AM, et al. Neurodevelopmental outcomes of extremely low-gestational-age neonates with low-grade periventricular-intraventricular hemorrhage. JAMA Pediatr 2013; 167:451.
- Ancel PY, Livinec F, Larroque B, et al. Cerebral palsy among very preterm children in relation to gestational age and neonatal ultrasound abnormalities: the EPIPAGE cohort study. Pediatrics 2006; 117:828.
- Sherlock RL, Anderson PJ, Doyle LW, Victorian Infant Collaborative Study Group. Neurodevelopmental sequelae of intraventricular haemorrhage at 8 years of age in a regional cohort of ELBW/very preterm infants. Early Hum Dev 2005; 81:909.
- Patra K, Wilson-Costello D, Taylor HG, et al. Grades I-II intraventricular hemorrhage in extremely low birth weight infants: effects on neurodevelopment. J Pediatr 2006; 149:169.
- Maalouf EF, Duggan PJ, Counsell SJ, et al. Comparison of findings on cranial ultrasound and magnetic resonance imaging in preterm infants. Pediatrics 2001; 107:719.
- Horsch S, Skiöld B, Hallberg B, et al. Cranial ultrasound and MRI at term age in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 2010; 95:F310.
- Ho T, Dukhovny D, Zupancic JA, et al. Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value. Pediatrics 2015; 136:e482.
- Eichenwald EC. Neuroimaging of extremely preterm infants: perils of prediction. Pediatrics 2015; 135:e176.
- Woodward LJ, Anderson PJ, Austin NC, et al. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 2006; 355:685.
- Hintz SR, Barnes PD, Bulas D, et al. Neuroimaging and neurodevelopmental outcome in extremely preterm infants. Pediatrics 2015; 135:e32.
- Brown NC, Inder TE, Bear MJ, et al. Neurobehavior at term and white and gray matter abnormalities in very preterm infants. J Pediatr 2009; 155:32.
- Woodward LJ, Clark CA, Bora S, Inder TE. Neonatal white matter abnormalities an important predictor of neurocognitive outcome for very preterm children. PLoS One 2012; 7:e51879.
- Iwata S, Nakamura T, Hizume E, et al. Qualitative brain MRI at term and cognitive outcomes at 9 years after very preterm birth. Pediatrics 2012; 129:e1138.
- Ullman H, Spencer-Smith M, Thompson DK, et al. Neonatal MRI is associated with future cognition and academic achievement in preterm children. Brain 2015; 138:3251.
- Cheong JL, Thompson DK, Spittle AJ, et al. Brain Volumes at Term-Equivalent Age Are Associated with 2-Year Neurodevelopment in Moderate and Late Preterm Children. J Pediatr 2016; 174:91.
- Nosarti C, Rushe TM, Woodruff PW, et al. Corpus callosum size and very preterm birth: relationship to neuropsychological outcome. Brain 2004; 127:2080.
- Fearon P, O'Connell P, Frangou S, et al. Brain volumes in adult survivors of very low birth weight: a sibling-controlled study. Pediatrics 2004; 114:367.
- Allin M, Henderson M, Suckling J, et al. Effects of very low birthweight on brain structure in adulthood. Dev Med Child Neurol 2004; 46:46.
- Constable RT, Ment LR, Vohr BR, et al. Prematurely born children demonstrate white matter microstructural differences at 12 years of age, relative to term control subjects: an investigation of group and gender effects. Pediatrics 2008; 121:306.
- Kesler SR, Reiss AL, Vohr B, et al. Brain volume reductions within multiple cognitive systems in male preterm children at age twelve. J Pediatr 2008; 152:513.
- Nosarti C, Giouroukou E, Healy E, et al. Grey and white matter distribution in very preterm adolescents mediates neurodevelopmental outcome. Brain 2008; 131:205.
- Ment LR, Kesler S, Vohr B, et al. Longitudinal brain volume changes in preterm and term control subjects during late childhood and adolescence. Pediatrics 2009; 123:503.
- Martinussen M, Flanders DW, Fischl B, et al. Segmental brain volumes and cognitive and perceptual correlates in 15-year-old adolescents with low birth weight. J Pediatr 2009; 155:848.
- Soria-Pastor S, Padilla N, Zubiaurre-Elorza L, et al. Decreased regional brain volume and cognitive impairment in preterm children at low risk. Pediatrics 2009; 124:e1161.
- de Kieviet JF, Zoetebier L, van Elburg RM, et al. Brain development of very preterm and very low-birthweight children in childhood and adolescence: a meta-analysis. Dev Med Child Neurol 2012; 54:313.
- van Wezel-Meijler G, De Bruïne FT, Steggerda SJ, et al. Ultrasound detection of white matter injury in very preterm neonates: practical implications. Dev Med Child Neurol 2011; 53 Suppl 4:29.
- Fogtmann EP, Plomgaard AM, Greisen G, Gluud C. Prognostic Accuracy of Electroencephalograms in Preterm Infants: A Systematic Review. Pediatrics 2017; 139.
- Voss W, Neubauer AP, Wachtendorf M, et al. Neurodevelopmental outcome in extremely low birth weight infants: what is the minimum age for reliable developmental prognosis? Acta Paediatr 2007; 96:342.
- Ment LR, Vohr B, Allan W, et al. Change in cognitive function over time in very low-birth-weight infants. JAMA 2003; 289:705.
- Wong HS, Santhakumaran S, Cowan FM, et al. Developmental Assessments in Preterm Children: A Meta-analysis. Pediatrics 2016; 138.
- Marlow N, Wolke D, Bracewell MA, et al. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 2005; 352:9.
- Doyle LW, Cheong JL, Burnett A, et al. Biological and Social Influences on Outcomes of Extreme-Preterm/Low-Birth Weight Adolescents. Pediatrics 2015; 136:e1513.
- Vohr B, Wright LL, Hack M, et al. Follow-up care of high-risk infants. Pediatrics 2004; 114 (Suppl 5):1377.
- Young JM, Morgan BR, Powell TL, et al. Associations of Perinatal Clinical and Magnetic Resonance Imaging Measures with Developmental Outcomes in Children Born Very Preterm. J Pediatr 2016; 170:90.
- Amiel-Tison C, Grenier A. Neurologic Evaluation of the Infant and Newborn, Masson Publishing, New York 1983.
- van Noort-van der Spek IL, Franken MC, Weisglas-Kuperus N. Language functions in preterm-born children: a systematic review and meta-analysis. Pediatrics 2012; 129:745.
- Spittle A, Orton J, Anderson PJ, et al. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev 2015; :CD005495.
- Enhancing the outcomes of low-birth-weight, premature infants. A multisite, randomized trial. The Infant Health and Development Program. JAMA 1990; 263:3035.
- Van Hus J, Jeukens-Visser M, Koldewijn K, et al. Early intervention leads to long-term developmental improvements in very preterm infants, especially infants with bronchopulmonary dysplasia. Acta Paediatr 2016; 105:773.
- Spittle AJ, Barton S, Treyvaud K et al. School-Age Outcomes of Early Intervention for Preterm Infants and Their Parents: A Randomized Trial. Pediatrics 2016.
- 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 with risk factors including <30 weeks gestation
- - Neurologic assessment
- Cerebral palsy
- - Hearing
- - Vision
- - Cognitive and motor assessment
- Early intervention programs
- - United States
- SUMMARY AND RECOMMENDATIONS