679 - Long-Term Neurosensory and Psychiatric Outcomes in Adolescents Born Very Preterm: A Nationwide register-based Study on the Impact of Neonatal Brain Injury

Publication Number: 679.5861

Malin Salonen, University of Turku, Finland, Vörå, Pohjanmaa, Finland; Kjell Helenius, University of Turku, Turku, Varsinais-Suomi, Finland; Juho Joutsa, University of Turku, Turku, Varsinais-Suomi, Finland; Tero Vahlberg, University of Turku, Turku, Varsinais-Suomi, Finland

Background: Brain injury (Intraventricular haemorrhage, IVH; cystic periventricular leukomalacia, cPVL) is a common complication of preterm birth, and associated with poor short-term neurological outcomes. However, data on long-term outcomes into adolescence is limited.

Objective: To determine whether children born preterm who experienced IVH or cPVL during the neonatal period exhibit a higher prevalence of neurosensory or psychiatric disorders by 16-17 years of age.

Design/Methods: Nationwide retrospective register study on very preterm infants (gestational age < 32 weeks or birth weight < 1501g) in the Finnish National Birth Register from Jan 1st, 2005 to Dec 31st 2006. Prevalence of selected ICD-10 diagnoses, including neurological (class G), psychiatric (F), visual (H30-59) and hearing disorders (H90-91) by the age of 16-17 years were obtained from the National Hospital Discharge register. The primary outcome was death and/or any of the specified ICD-10 diagnoses, secondary outcomes were individual diagnosis classes. The results were adjusted for gestational age, infant sex, receipt of antenatal corticosteroids, and birth in level 3 hospital.

Results: Of a total 1,028 infants, 59 infants were excluded because of death before 3 days of age without any record of brain US, and 15 infants were excluded due to non-IVH/cPVL brain injury diagnoses. Of the remaining 953 infants, 184 had a neonatal brain injury (109 grade 1-2 IVH [mild]; 75 grade 3-4 IVH and/or cPLV [severe]), and 769 had no diagnosis of a brain injury. 65 infants died during the initial hospitalization, and additional 14 before the age of 16-17 years.

In the unadjusted analyses, severe brain injury was significantly associated with the primary outcome and all diagnosis classes, except for hearing disorders. In the adjusted analyses, severe brain injury was significantly associated with the primary outcome aOR (8.59 (4.04-18.23); and neurological (aOR 12.99 (6.77-24.93); psychiatric (aOR 2.40 (1.38-4.18); and visual disorders (aOR 2.13 (1.17-3.87). However, mild brain injury was not significantly associated with any of the studied outcomes.

Conclusion(s): Very preterm infants with mild brain injury had no significant differences in long-term outcomes compared to controls. However, severe brain injury remains a strong risk factor for adverse long-term outcomes, motivating actions towards better prevention and treatment.

Table 1. Association of different grades of brain injury and death or neurosensory or psychiatric diagnoses by the age of 16-17 years among infants born very preterm.
Table 1_M.Salonen.jpeg