619 - Neurodevelopmental Outcomes at 18-24 Months in Preterm Infants Born at 23-29 Weeks Without Apparent Brain Injury.

Publication Number: 619.6016

jinwha choi, medical, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Byongsop LEE, Asan Medical Center, Seoul, Seoul-t'ukpyolsi, Republic of Korea

Background: Although the survival rate of VLBWI has improved significantly, it is still challengeable to predict and manage the neurodevelopmental prognosis of VLBWIs. Although several risk factors are known, even preterm infants without evidence of brain injury are not exempt from the neurodevelopmental impairment(NDI). Additionally, there is currently no research on this matter. Consequently, a comprehensive analysis using the data from the Korean Neonatal Network(KNN) is needed to assess the neurodevelopmental outcomes of preterm infants without apparent brain injury.

Objective: To examine the epidemiology of developmental outcomes in VLBWIs without clinically confirmed brain injury and to identify perinatal factors predictive of these outcomes.

Design/Methods: This study includes preterm infants registered in the KNN who were born between 2013 and 2020, with a birth weight of less than 1500g and a gestational age of 23 to 29 weeks. Included infants had no history of neonatal seizures, grade 2 or higher IVH, post-hemorrhagic hydrocephalus, cystic PVL, meningitis, congenital anomalies, or congenital infections. Only infants who survived and underwent the BSID-II or III at a corrected age of 18-24 months were analyzed. We evaluated the neurodevelopmental outcomes of these infants and analyzed the associations with perinatal characteristics.

Results: Cognitive impairment(CI) was observed in 18.7%, motor impairment(MI) in 1.2%, while visual impairment(VI) and hearing loss(HL) were present in 0% and 0.9% of the population, respectively. The factors that were notably associated with NDI included maternal PIH, SGA, pulmonary hypertension, BPD, moderate or higher, PDA ligation, ROP requiring laser operation, length of hospital stay, and SGA at discharge. In the multivariate analysis, common factors associated with both any NDI and CI included maternal educational level, SGA, and length of hospital stay. CI specifically was significantly associated with PDA ligation, whereas any NDI was associated with pulmonary hypertension and histologic chorioamnionitis. Interestingly, histologic chorioamnionitis showed a protective effect against NDI.

Conclusion(s): VLBW infants without apparent brain injury are not exempt from the risk of neurodevelopmental impairment, with factors like SGA, pulmonary hypertension, PDA ligation and prolonged hospital stay being significant predictors. The protective effect of histologic chorioamnionitis warrants further investigation. Identifying and addressing these perinatal risk factors could enhance early intervention strategies and improve long-term outcomes in this vulnerable population.

Table 1. Clinical Characteristics of Preterm Infants Born at 23-29 Weeks' Gestation Without Major Brain Injury, Assessed at 18-24 Months' Corrected Age. (n=2349)
Presented as mean +/- SD or % of n ().
PIH, Pregnancy induced hypertension; PROM, Pre-labor rupture of membranes; GDM, Gestational diabetes mellitus; SGA, small for gestational age; RDS, Respiratory distress syndrome; BPD, Bronchopulmonary dysplasia, PDA, patent ductus arteriosus; NEC, necrotizing enterocolitis, ROP, Retinopathy of prematurity; SGA, small for gestational age


Table 2. Neurodevelopmental Outcomes at 18 to 24 months of corrected age of Preterm Infants Born at 23-29 Weeks' Gestation Without Major Brain Injury, Assessed at 18-24 Months' Corrected Age. (n=2349)
* Visual impairment was defined as bilateral loss of vision, and hearing loss was defined as bilateral hearing loss or the use of hearing aids.
* MDI, Mental Developmental Index; GMFCS, Gross Motor Function Classification System.
* Cognitive impairment was defined as a BSID-II MDI score <70 or a BSID-III Cognitive Composite score <85, and motor impairment was defined as a GMFCS level of 2 or higher. Neurodevelopmental impairment (NDI) was defined as the presence of at least one of the following: motor impairment, cognitive impairment, visual impairment, or hearing loss.


Table 3. Perinatal characteristics by Neurodevelopmental impairment category.
* Cognitive impairment was defined as a BSID-II MDI score <70 or a BSID-III Cognitive Composite score <85, and motor impairment was defined as a GMFCS level of 2 or higher. Visual impairment was defined as bilateral loss of vision, and hearing loss was defined as bilateral hearing loss or the use of hearing aids. Neurodevelopmental impairment (NDI) was defined as the presence of at least one of the following: motor impairment, cognitive impairment, visual impairment, or hearing loss. Neurosensory impairment was defined as moderate or severe cerebral palsy, Gross Motor Function Classification System level of at least 2, profound hearing loss, or profound visual impairment.