Neonatal morbidities and developmental delay in moderately preterm-born children

BACKGROUND AND OBJECTIVE: Children born moderately preterm (32-35(6/7) weeks' gestation) are at increased risk of both neonatal morbidities and developmental delays in early childhood. It is unknown whether neonatal morbidities contribute to the increased risk of developmental delay. The objective of this study was to determine the effect of neonatal morbidities after moderately preterm birth on development at preschool age. METHODS: In a community-based, stratified cohort, parents of 832 moderately preterm children born in 2002 or 2003 completed the Ages and Stage Questionnaire when their child was 43 to 49 months old. Data on Apgar scores, asphyxia, tertiary NICU admission, hospital transfer, circulatory insufficiency, hypoglycemia, septicemia, mechanical ventilation, continuous positive airway pressure, apneas, caffeine treatment, and hyperbilirubinemia were obtained from medical records. We assessed associations of neonatal characteristics with developmental delay, adjusted for gender, small-for-gestational-age status, gestational age, and maternal education. RESULTS: Hypoglycemia and asphyxia were associated with developmental delay; odds ratios (ORs) were 2.42 (95% confidence interval [CI]: 1.23-4.77) and 3.18 (95% CI: 1.01-10.0), respectively. Tertiary NICU admission and hyperbilirubinemia had positive but statistically borderline nonsignificant associations with developmental delay: ORs were 1.74 (95% CI: 0.96-3.15) and 1.52 (95% CI: 0.94-2.46), respectively. No other neonatal morbidities were associated with developmental delay. In multivariate analyses, only hypoglycemia was associated with developmental delay (OR: 2.19; 95% CI: 1.08-4.46). CONCLUSIONS: In moderately preterm-born children, only hypoglycemia increased the risk of developmental delay at preschool age. A concerted effort to prevent hypoglycemia might enhance developmental outcome in this group

Outliers Matter

The purpose of this thesis is to evaluate outcome after non-cardiac surgery and thereby identify the “outliers”, meaning patients with risks beyond the conventional risk factors

Growth of preterm-born children

Groei van vroeggeboren kinderen verloopt anders dan die van op tijd geborenen Kinderen die te vroeg geboren zijn (voor de 37ste zwangerschapsweek) groeien volgens een ander patroon dan kinderen die op tijd zijn geboren. Ze moeten daarom niet, zoals de Wereld Gezondheidsorganisatie WHO wil, beschouwd worden als op tijd geborenen. Dat concludeert Inger Bocca-Tjeertes in haar promotieonderzoek. De vooruitzichten van kinderen die te vroeg of veel te vroeg (voor de 32 ste week) geboren worden, zijn door verbeterde neonatale zorg steeds beter. Hoewel vroeggeboortes steeds vaker voorkomen, zijn er weinig gegevens over de groei van premature baby´s beschikbaar. Bocca-Tjeertes ontwikkelde, samen met haar collega’s en op basis van een omvangrijk gegevensbestand, groeidiagrammen voor mild en ernstig vroeggeboren kinderen. Haar conclusie: die groei verloopt echt anders dan die van op tijd geborenen. Weliswaar vindt er inhaalgroei plaats, maar die is beperkt tot het eerste jaar na de geboorte en kan de gevolgen van vroeggeboorte niet helemaal compenseren. Dat geldt voor te vroeg geboren kinderen met en zonder groeivertraging bij de geboorte. Wel zorgt groeivertraging bij de geboorte voor een twee keer hoger risico op een ontwikkelingsachterstand. Om de groei goed te monitoren, pleit Bocca-Tjeertes ervoor om aangepaste groeidiagrammen te gebruiken en om de groei steeds te verbinden met de individuele geboortegegevens

Risk of developmental delay increases exponentially as gestational age of preterm infants decreases:a cohort study at age 4 years

Aim The aim of the study was to assess the influence of decreasing gestational age on the risk of developmental delay in various domains at age 4 years among children born at a wide range of gestational ages. Method In a community-based cohort, the parents of 1439 preterm-born children (24 0/7 to 35 6/7wks) and 544 term-born children (38 0/7 to 41 6/7wks) born in 2002 and 2003 completed the Ages and Stages Questionnaire (ASQ) when their child was 3 years 7 months to 4 years 1 month old. The prevalence rates of abnormal scores on the ASQ-total problems scale were compared in preterm and term-born children and the resulting odds ratios for gestational age groups were calculated and adjusted for social and biological covariates. Results The prevalence rates of abnormal scores on the ASQ-total problems scale increased with decreasing gestational age: from 4.2% among term-born children to 37.5% among children born at 2425 weeks gestation (p Interpretation The risk of developmental delay increases exponentially with decreasing gestational age below 36 weeks gestation on all developmental domains of the ASQ. Adjustment for covariates did not alter the pattern of exponential increase in developmental risk with decreasing gestational age. We speculate that both direct perinatal cerebral injuries and tropic and maturational brain disturbances are involved