Prediction of outcome at 5 years from assessments at 2 years among extremely preterm children: a Norwegian national cohort study

Scandinavian perspectives on life support at the border of viability

Advances in neonatal medicine have allowed us to rescue extremely preterm infants. However, both long-term vulnerability and the burden of treatment in the neonatal period increase with decreasing gestational age. This raises questions about the justification of life support when a baby is born at the border of viability, and has led to a so-called "grey zone", where many professionals are unsure whether provision of life support is in the child's best interest. Despite cultural, political and economic similarities, the Scandinavian countries differ in their approach to periviable infants, as seen in their respective national guidelines and practices. In Sweden, guidelines and practice are more rescue-focused at the lower end of the border of viability, Danish guidelines emphasizes the need to involve parental views in the decision-making process, whereas Norway appears to be somewhere in between. In this paper, I will give an overview of national consensus documents and practices in Norway, Sweden and Denmark, and reflect on the ethical justification for the different approaches.

Maternal education and cognitive development in 15 European very-preterm birth cohorts from the RECAP Preterm platform

BACKGROUND

Studies are sparse and inconclusive about the association between maternal education and cognitive development among children born very preterm (VPT). Although this association is well established in the general population, questions remain about its magnitude among children born VPT whose risks of medical and developmental complications are high. We investigated the association of maternal education with cognitive outcomes in European VPT birth cohorts.

METHODS

We used harmonized aggregated data from 15 population-based cohorts of children born at <32 weeks of gestational age (GA) or <1500 g from 1985 to 2013 in 13 countries with information on maternal education and assessments of general development at 2-3 years and/or intelligence quotients between 4 and 15 years. Term-born controls (≥37 weeks of GA) were available in eight cohorts. Maternal education was classified as: low (primary/lower secondary); medium (upper secondary/short tertiary); high (bachelor's/higher). Pooled standardized mean differences (SMDs) in cognitive scores were estimated (reference: high educational level) for children assessed at ages 2-3, 4-7 and 8-15 years.

RESULTS

The study included 10 145 VPT children from 12 cohorts at 2-3 years, 8829 from 12 cohorts at 4-7 years and 1865 children from 6 cohorts at 8-15 years. Children whose mothers had low, compared with high, educational attainment scored lower on cognitive measures [pooled unadjusted SMDs: 2-3 years = -0.32 (95% confidence intervals: -0.43 to -0.21); 4-7 years = -0.57 (-0.67; -0.47); 8-15 years = -0.54 (-0.72; -0.37)]. Analyses by GA subgroups (<27 vs ≥27 weeks) in children without severe neonatal morbidity and term controls yielded similar results.

CONCLUSIONS

Across diverse settings and regardless of the degree of prematurity, low maternal education was associated with lower cognition.

Predictors of persistent and changing developmental problems of preterm children

BACKGROUND

Accurate prediction of persistent and emerging developmental problems in preterm-born children may lead to targeted interventions.

AIMS

To determine whether specific perinatal and social factors were associated with persistent, emerging, and resolving developmental problems of early-preterm (EPs) and moderately-and-late-preterm children (MLPs) from before to after school entry.

STUDY DESIGN

Observational longitudinal cohort study, part of the LOLLIPOP cohort-study.

SUBJECTS

341 EPs and 565 MLPs.

OUTCOME MEASURES

Developmental problems using the Ages and Stages Questionnaire at ages 4 and 5. We collected data on perinatal and social factors from medical records. Using logistic regression analyses we assessed associations between 48 factors and persistent, emerging, and resolving problems.

RESULTS

Of EPs, 8.7% had persistent and 5.1% emerging problems; this was 4.3% and 1.9% for MLPs, respectively. Predictors for persistent problems included chronic mental illness of the mother, odds ratio (95% confidence interval) 8.01 (1.85-34.60), male sex 4.96 (2.28-10.82), being born small-for-gestational age (SGA) 2.39 (1.15-4.99), and multiparity 3.56 (1.87-6.76). Predictors for emerging problems included MLP birth with prolonged premature rupture of membranes (PPROM) 5.01 (1.38-18.14). Including all predictors in a single prediction model, the explained variance (Nagelkerke R²) was 21.9%, whereas this was 3.0% with only EP/MLP birth as predictor.

CONCLUSIONS

Only few perinatal and social factors had associations with persistent and emerging developmental problems for both EPs and MLPs. For children with specific neonatal conditions such as SGA, and PPROM in MLPs, problems may persist. Insight in risk factors largely improved the prediction of developmental problems among preterm children.

Follow-Up de Nascidos Prematuros: Uma Revisão Sistemática da Literatura

Resumo Objetivou-se mapear estudos científicos sobre follow-up de prematuros na área da psicologia. Buscou-se no portal BVS artigos empíricos publicados até dezembro de 2017 pelos descritores prematur* AND follow up AND child AND psychology. A partir dos critérios adotados, analisou-se 48 artigos, nas categorias: faixa etária em que os prematuros foram avaliados; objetivos do estudo; tipo de avaliação realizada; e resultados encontrados. Destaca-se que a metade realizou o follow-up entre o nascimento e a adolescência, a maioria investigou o desenvolvimento neuropsicológico e encontrou associações entre a prematuridade, déficits cognitivos e psicológicos. Compreende-se que os estudos priorizam as repercussões no desenvolvimento de habilidades e competências, dando pouca atenção aos aspectos psíquicos e às interações criança-pais-ambiente.

Effortful control and attention as predictors of cognition in children born preterm

BACKGROUND

Preterm childbirth increases the risk of developmental problems. The aim of the present study was to examine the effects of temperament and attention on the cognition of school-age children who were born preterm, controlling for socioeconomic variables.

MATERIAL AND METHODS

The sample was composed of 50 six-year-old children who were born preterm with very low birth weight. The children were evaluated using the Wechsler Intelligence Scale for Children (WISC-III) and the Cancellation Attention Test. The mothers were interviewed using the Children's Behavior Questionnaire (CBQ). Statistical multiple linear regression analyses were performed.

RESULTS

70% of the children presented average or above-average full intellectual quotient (IQ). In the attention total score, 74% of the children were also within the average range or above. High verbal IQ associated with high maternal schooling explained 73% variability of the full IQ. High attention and maternal schooling, associated with children's temperament with more effortful control, explained 35% variability of the verbal IQ. High attention, associated with high maternal schooling and socioeconomic level, explained 37% variability of the performance IQ. The neonatal clinical variables (gestational age, birth weight, 5th-minute Apgar, and length of stay in neonatal intensive care unit (NICU) and hospital) were not predictors of cognitive outcomes.

CONCLUSION

The majority of the children who were born preterm presented average or above-average cognitive and attentional performances at school age, demonstrating potential resources for learning. Taken together, attention and temperament, associated with maternal schooling and socioeconomic status, were predictors of cognitive outcomes of children born preterm at school age.

As-indicated versus routine vision screening of preterm children: a 17-year retrospective regional study

PURPOSE

To investigate outcomes of routine vision screening compared to as-indicated ophthalmological investigation of all children born preterm in a Danish region from 1997 to 2014.

METHODS

All children born preterm (gestation age < 32 weeks or birthweight < 1500 g) screened for retinopathy of prematurity (ROP) were divided into two groups. From 1997 to 2009, only children treated for ROP or referred for visual problems received ophthalmological investigation (as-indicated group). From 2010 to 2014, all ROP-screened infants were offered ophthalmological investigation at 6 months and 3 years of age (screening group).

RESULTS

A total of 560 children were included in the as-indicated period, 41 and 87 were referred for ophthalmological investigation at 6 months and 3 years, respectively. In the screening period, 295 children were included, 251 and 150 of whom underwent vision evaluation at 6 months and 3 years, respectively. Mean visual acuity was 4.1 cycles per degree with Teller acuity cards at 6 months and 0.78 decimal at 3 years. At 3 years, 2.7%(n = 11) in the as-indicated versus 3.5%(n = 10) screening group had visual acuity < 6/18 (p = 0.24). Cerebral palsy (n = 28) and epilepsy (n = 5) were significantly related to vision impairment (p = 0.001/0.006), while treated ROP was not (n = 13). Refractive error was common at 3 years (61%), especially astigmatism (50%). Gestational age, birthweight and ROP were not associated with vision impairment or refractive error.

CONCLUSION

Screening preterm children at 6 months and 3 years did not reveal more visually impaired children compared to examination when indicated.

Association between perinatal interventional activity and 2-year outcome of Swiss extremely preterm born infants: a population-based cohort study

OBJECTIVES

To investigate if centre-specific levels of perinatal interventional activity were associated with neonatal and neurodevelopmental outcome at 2 years of age in two separately analysed cohorts of infants: cohort A born at 22-25 and cohort B born at 26-27 gestational weeks, respectively.

DESIGN

Geographically defined, retrospective cohort study.

SETTING

All nine level III perinatal centres (neonatal intensive care units and affiliated obstetrical services) in Switzerland.

PATIENTS

All live-born infants in Switzerland in 2006-2013 below 28 gestational weeks, excluding infants with major congenital malformation.

OUTCOME MEASURES

Outcomes at 2 years corrected for prematurity were mortality, survival with any major neonatal morbidity and with severe-to-moderate neurodevelopmental impairment (NDI).

RESULTS

Cohort A associated birth in a centre with high perinatal activity with low mortality adjusted OR (aOR 0.22; 95% CI 0.16 to 0.32), while no association was observed with survival with major morbidity (aOR 0.74; 95% CI 0.46 to 1.19) and with NDI (aOR 0.97; 95% CI 0.46 to 2.02). Median age at death (8 vs 4 days) and length of stay (100 vs 73 days) were higher in high than in low activity centres. The results for cohort B mirrored those for cohort A.

CONCLUSIONS

Centres with high perinatal activity in Switzerland have a significantly lower risk for mortality while having comparable outcomes among survivors. This confirms the results of other studies but in a geographically defined area applying a more restrictive approach to initiation of perinatal intensive care than previous studies. The study adds that infants up to 28 weeks benefited from a higher perinatal activity and why further research is required to better estimate the added burden on children who ultimately do not survive.

Physician characteristics influence the trends in resuscitation decisions at different ages

AIM

We examined how physicians in different medical specialties would evaluate treatment decisions for vulnerable patients in need of resuscitation.

METHODS

A survey depicting six acutely ill patients from newborn infant to aged, all in need of resuscitation with similar prognoses, was distributed (in 2009) to a representative sample of 1650 members of the Norwegian Medical Association and 676 members of the Norwegian Pediatric Association.

RESULTS

There were 1335 respondents (57% participation rate). The majority of respondents across all specialties thought resuscitation was in the best interest of a 24 weeks' gestation preterm infant and would resuscitate the patient, but would also accept palliative care on the family's demand. Accepting a family's refusal of resuscitation was more common for the newborn infants. Specialists were overall similar in their answers, but specialty, age and gender were associated with different answers for the patients at both ends of the age spectrum.

CONCLUSION

Resuscitation decisions for the very young do not always seem to follow the best interest principle. Specialty and personal characteristics still have an impact on how we consider important ethical issues. We must be cognisant of our own valuations and how they may influence care.

Neurodevelopmental Impairment Among Extremely Preterm Infants in the Neonatal Research Network

OBJECTIVES

Evaluate the spectrum of neurodevelopmental outcome in a contemporary cohort of extremely preterm infants. We hypothesize that the rate of severe neurodevelopmental impairment (NDI) decreases over time.

METHODS

Retrospective analysis of neurodevelopmental outcome of preterm infants ≤27 weeks' gestational age (GA) from a Neonatal Research Network center that completed neurodevelopmental follow-up assessments between April 1, 2011, and January 1, 2015. The Bayley Scales of Infant Development-III (BSID III) and a standardized neurosensory examination were performed between 18 and 26 months' adjusted age. Outcome measures were neurologic examination diagnoses, BSID III cognitive and motor scores, sensory impairment, and the composite outcome of NDI, based on the BSID III cognitive score (analyzed by using a cutoff of <85 or <70), BSID III motor score of <70, moderate or severe cerebral palsy (CP), bilateral blindness, and hearing impairment.

RESULTS

Two thousand one hundred and thirteen infants with a mean GA of 25.0 ± 1.0 weeks and mean birth weight of 760 ± 154 g were evaluated. The 11% lost to follow-up were less likely to have private insurance, late-onset sepsis, or severe intraventricular hemorrhage. Neurologic examination results were normal in 59%, suspect abnormal in 19%, and definitely abnormal in 22%. Severe CP decreased 43% whereas mild CP increased 13% during the study. The rate of moderate to severe NDI decreased from 21% to 16% when using the BSID III cognitive cutoff of <70 (P = .07) or from 34% to 31% when using the BSID III cognitive cutoff of <85 (P = .67).

CONCLUSIONS

Extremely preterm children are at risk for NDI. Over time, the rate of moderate to severe NDI did not differ, but the rates of severe CP decreased, and mild CP increased.

Neurodevelopmental outcome in very preterm and very-low-birthweight infants born over the past decade: a meta-analytic review

AIM

The purpose of this systematic review was to provide an up-to-date global overview of the separate prevalences of motor and cognitive delays and cerebral palsy (CP) in very preterm (VPT) and very-low-birthweight (VLBW) infants.

METHOD

A comprehensive search was conducted across four databases. Cohort studies reporting the prevalence of CP and motor or cognitive outcome from 18 months corrected age until 6 years of VPT or VLBW infants born after 2006 were included. Pooled prevalences were calculated with random-effects models.

RESULTS

Thirty studies were retained, which included a total of 10 293 infants. The pooled prevalence of cognitive and motor delays, evaluated with developmental tests, was estimated at 16.9% (95% confidence interval [CI] 10.4-26.3) and 20.6% (95% CI 13.9-29.4%) respectively. Mild delays were more frequent than moderate-to-severe delays. Pooled prevalence of CP was estimated to be 6.8% (95% CI 5.5-8.4). Decreasing gestational age and birthweight resulted in higher prevalences. Lower pooled prevalences were found with the Third Edition of the Bayley Scales of Infant Development than with the Second Edition.

INTERPRETATION

Even though neonatal intensive care has improved over recent decades, there is still a wide range of neurodevelopmental disabilities resulting from VPT and VLBW births. However, pooled prevalences of CP have diminished over the years.

WHAT THIS PAPER ADDS

The Bayley Scales of Infant and Toddler Development, Third Edition reported lower pooled prevalences of motor and cognitive delays than the Second Edition. The pooled prevalence of cerebral palsy in infants born extremely preterm was reduced compared with previous meta-analyses.

The Predictive Value of Developmental Assessments at 1 and 2 for Intelligence Quotients at 6

Intelligence is an important individual difference factor related to mental health, academic achievement, and life success, yet there is a lack of research into its early cognitive predictors. This study investigated the predictive value of infant developmental assessment scores for school-age intelligence in a large, heterogeneous sample of single- and twin-born subjects (N = 521). We found that Early Learning Composite (ELC) scores from the Mullen Scales of Early Learning have similar predictive power to that of other infant tests. ELC scores at age 2 were predictive of Stanford-Binet abbreviated intelligence (ABIQ) scores at age 6 (r = 0.46) even after controlling for sex, gestation number, and parental education. ELC scores at age 1 were less predictive of 6-year ABIQ scores (r = 0.17). When the sample was split to test robustness of findings, we found that results from the full sample replicated in a subset of children born at ≥32 weeks gestation without birth complications (n = 405), though infant cognitive scores did not predict IQ in a subset born very prematurely or with birth complications (n = 116). Scores at age 2 in twins and singletons showed similar predictive ability for scores at age 6, though twins had particularly high correlations between ELC at age 1 and ABIQ at age 6.

Stability of Developmental Problems after School Entry of Moderately-Late Preterm and Early Preterm-Born Children

OBJECTIVE

To assess the stability of developmental problems in moderately-late preterm-born children compared with early preterm and full term-born children before school entry at age 4 years and 1 year after school entry at age 5 years.

STUDY DESIGN

We included 376 early preterm, 688 born moderately-late preterm, and 403 full term-born children from the Longitudinal Preterm Outcome Project (LOLLIPOP) cohort study. Developmental problems were assessed by the total score and the 5 domain scores of the Ages and Stages Questionnaire at ages 4 (ASQ-4) and 5 (ASQ-5). From the combinations of normal and abnormal ASQ-4 and ASQ-5 scores we constructed 4 categories: consistently normal, emerging, resolving, and persistent problems.

RESULTS

The ASQ-4 total score was abnormal more frequently in moderately-late preterm (7.9%, P = .016) and early preterm-born children (13.0%, P < .001) than in full term-born children (4.1%). Compared with the ASQ-5 total score, moderately-late preterm-born children had persistence and change comparable with full term-born children, and early preterm-born children had significantly greater rates than full term-born children of persistent (8.4% vs 2.2%, P < .001) and emerging problems (7.8% vs 2.7% P = .001). On the underlying domains, both early preterm and moderately-late preterm-born children had mainly emerging motor problems and resolving communication problems, but the changing rates of moderately-late preterm-born children were lower.

CONCLUSIONS

After school entry, the overall development of moderately-late preterm-born children had stability patterns comparable with full term-born children, whereas early preterm-born children had greater rates of persistent and emerging problems. On the underlying domains, moderately-late preterm-born children had patterns comparable with early preterm-born children but at lower rates.

Neuropsychological Outcomes of Preterm Birth in Children With No Major Neurodevelopmental Impairments in Early Life

Objectives

To investigate cognition, social adaptive functioning, behavior, and emotional development in the preschool period and to determine the effects of the age of onset of walking on those developmental areas in children who were born preterm without major neurodevelopmental impairments (NDI) early in life.

Methods

Fifty-eight children who were born preterm without major NDI early in life participated in this study. The Korean versions of the Wechsler Preschool and Primary Scale of Intelligence or the Bayley Scales of Infant Development, the social maturity scale, the Korean version of the Child Behavior Checklist (CBCL), Conners' abbreviated parent/teacher rating scale, the Childhood Autism Rating Scale, and a speech developmental test were administered. The participants were divided into two groups: early walkers (group A) and late walkers (group B).

Results

The full-scale intelligence quotient (IQ) and performance IQ were significantly lower in group B than in group A, while the verbal IQ did not differ significantly between the groups. The children in group B had greater risks of cognitive deficits than did the children in group A, especially in performance skills. The social quotient (SQ) was significantly lower in group B than in group A (p<0.05). The rates of mild or significant deficits based on SQ and the CBCL did not differ significantly between the groups. Four children in group A and one child in group B had attention/hyperactivity problems. One child in group A had autistic behavior. Only one child in group B showed a significant speech developmental delay.

Conclusions

Problems in cognition, social adaptive functioning, and emotional and behavioral development can occur in children without major NDI early in life. Late walkers had significantly lower scores in cognition and social adaptive functioning than did early walkers.

Predicting developmental delay in a longitudinal cohort of preschool children with single-suture craniosynostosis: is neurobehavioral assessment important?

AIM

The aim of this study was to determine whether neurobehavioral assessment before and after cranial vault surgery can improve prediction of developmental delay in children with single-suture craniosynostosis (SSC), after accounting for 'baseline' demographic and clinical variables (SSC diagnosis and surgery age).

METHOD

Children with SSC were referred by the treating surgeon or pediatrician before surgery. Neurobehavioral assessments were performed at ages of approximately 6, 18, and 36 months. Iterative models were developed to predict delay, as determined by one or more tests of cognitive, motor, and language skills at 36 months. We selected from groups of variables entered in order of timing (before or after corrective surgery), and source of information (parent questionnaire or psychometric testing).

RESULTS

Good predictive accuracy as determined by area under the receiver operating characteristic curve (AUC), was obtained with the baseline model (AUC=0.66), which incorporated age at surgery, sex, and socio-economic status. However, predictive accuracy was improved by including pre- and post-surgery neurobehavioral assessments. Models incorporating post-surgery neurobehavioral testing (AUC=0.79), pre-surgery testing (AUC=0.74), or both pre- and post-surgery testing (AUC=0.79) performed similarly. However, the specifity of all models was considered to be moderate (≤0.62).

INTERPRETATION

Prediction of delay was enhanced by assessment of neurobehavioral status. Findings provide tentative support for guidelines of care that call for routine testing of children with SSC.

Systematic Review of Cerebral Palsy Registries/Surveillance Groups: Relationships between Registry Characteristics and Knowledge Dissemination

The aims of this study were to provide a comprehensive summary of the body of research disseminated by Cerebral Palsy (CP) registries and surveillance programs from January 2009 through May 2014 in order to describe the influence their results have on our overall understanding of CP. Secondly, registries/surveillance programs and the work they produced were evaluated and grouped using standardized definitions and classification systems.

METHOD

A systematic review search in PubMed, CINAH and Embase for original articles published from 1 January 2009 to 20 May 2014 originating from or supported by population based CP registries and surveillance programs or population based national registries including CP were included. Articles were grouped by 2009 World CP Registry Congress aim, registry/surveillance program classification, geographical region, and the International Classification of Function, Disability and Health (ICF) domain. Registry variables were assessed using the ICF-CY classification.

RESULTS

Literature searches returned 177 articles meeting inclusion criteria. The majority (69%) of registry/surveillance program productivity was related to contributions as a Resource for CP Research. Prevention (23%) and Surveillance (22%) articles were other areas of achievement, but fewer articles were published in the areas of Planning (17%) and Raising the Profile of CP (2%). There was a range of registry/surveillance program classifications contributing to this productivity, and representation from multiple areas of the globe, although most of the articles originated in Europe, Australia, and Canada. The domains of the ICF that were primarily covered included body structures and function at the early stages of life. Encouragingly, a variety of CP registry/surveillance program initiatives included additional ICF domains of participation and environmental and personal factors.

INTERPRETATION

CP registries and surveillance programs, including novel non-traditional ones, have significantly contributed to the understanding of how CP affects individuals, families and society. Moving forward, the global CP registry/surveillance program community should continue to strive for uniformity in CP definitions, variables collected and consistency with international initiatives like the ICF so that databases can be consolidated for research use. Adaptation to new technologies can improve access, reduce cost and facilitate information transfer between registrants, researchers and registries/surveillance programs. Finally, increased efforts in documenting variables of individuals with CP into adulthood should be made in order to expand our understanding of CP across the lifespan.

Developmental trajectories of young children with neurofibromatosis type 1: a longitudinal study from 21 to 40 months of age

OBJECTIVE

To establish the developmental trajectory of young children with neurofibromatosis type 1 (NF1) during the first 4 years of life.

STUDY DESIGN

In this longitudinal study, 39 children with NF1 and 39 controls were assessed with the Bayley Scales of Infant Development, Second Edition at 21 (time point 1, or T1) and 30 months (T2) of age, and the Wechsler Preschool and Primary Scale of Intelligence, Third Edition at 40 months (T3). Language was also assessed at T2 and T3. Parents rated their child's productive vocabulary at T1 and T2, and behavior at each time point. Linear mixed models were performed to examine cognitive development and behavior over time. Linear regressions were conducted to determine whether mental development and productive vocabulary at T1 or T2 predicted intellectual and language outcomes at T3.

RESULTS

Over time, the NF1 group had significantly lower cognitive scores than controls. Parent ratings indicated no group differences in behavior at each time point. Earlier mental function significantly predicted later general intelligence. Earlier productive vocabulary was a significant predictor of later language skills.

CONCLUSIONS

There are consistent differences over time in cognitive performance between children with NF1 and unaffected peers during the early childhood period. Earlier mental function and productive vocabulary are significant predictors of subsequent general intelligence and performance on language measures in NF1. This provides an opportunity for early identification and treatment for young children with NF1 who may show signs of impairments in these developmental domains.

Predicting the outcome of specific language impairment at five years of age through early developmental assessment in preterm infants

BACKGROUND

Very preterm infants (<30 weeks of gestation) are at increased risk of specific language impairment and systematic developmental follow-up is essential for the provision of targeted early intervention.

AIMS

To define the predictive value of early language testing and stability of language development, and perinatal and demographic risk factors for the diagnosis of SLI at 5 years, in a cohort of preterm infants.

STUDY DESIGN

We used a retrospective hospital based cohort study.

SUBJECTS

Preterm infants <30 weeks of gestation, were cared for in NICU at RPAH, between 2004 and 2007, and prospectively enrolled in developmental follow-up. Standardised developmental assessment was done at 3 years utilising the Bayley Scales of Infant and Toddler Development-III and the Wechsler Preschool and Primary Scale of Intelligence-III was done at 5 years.

OUTCOME MEASURES

Predictive value and stability of early language testing were assessed with respect to SLI at 5 years, using measures of diagnostic accuracy and kappa values. Multivariate logistic regression was performed during the distribution of perinatal and demographic risk factors for SLI.

RESULTS

One-in-five met diagnostic criteria for SLI (19%, n=24). Limited diagnostic accuracy was found with early expressive language and the stability of language scores demonstrated only fair agreement (Cohen's κ .383). Multilingual status and extreme gestational age at 24-25 weeks were associated with a six-fold increased risk of SLI (OR 6.09, 95% CI 1.89-19.56; OR 6.09, 95% CI 1.28-29.0).

CONCLUSION

We defined a high incidence of SLI among our cohort, but only a limited diagnostic accuracy of early language testing. Multilingual status and extreme prematurity were independent risk factors for SLI. It remains imperative to perform continued developmental assessments beyond pre-school age to identify language impairment with greater accuracy.

Children born extremely preterm show significant lower cognitive, language and motor function levels compared with children born at term, as measured by the Bayley-III at 2.5 years

AIM

To assess developmental outcomes of children aged 2.5 years born extremely preterm.

METHODS

As a part of the population-based Extremely Preterm Infants in Sweden Study (EXPRESS), 399 children born before 27 weeks of gestation and 366 control children born at term were assessed with the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), assigning scores for cognition, receptive and expressive communication, fine and gross motor functions. Based on control group means, prevalences of developmental delay in the preterm group were calculated. Mean score differences between subtests constituting the overall Bayley-III indices were analysed within both groups.

RESULTS

After controlling for socio-demographic, child and assessment variables, analyses showed significantly lower performances of the preterm group compared with the control group on the Bayley-III subtests. Prevalence of moderate-severe delay was 10.8% in cognitive, 14.9% in receptive communication, 14.5% in expressive communication, 12.4% in fine motor and 7.0% in gross motor functions. Significant differences between performances on subtests included in the same indices were detected.

CONCLUSION

Extremely preterm children show significant lower cognitive, communicative and motor function levels at 2.5 years compared with children born at term. Bayley-III assessments permit the acquisition of nuanced information about development following extreme prematurity.

Long-term outcome at age 7-10 years after extreme prematurity - a prospective, two centre cohort study of children born before 25 completed weeks of gestation (1999-2003)

OBJECTIVE

We aimed to determine the long-term neurodevelopmental outcome in extremely preterm infants of 22-23 completed weeks' gestation as compared to infants of 24 weeks with immediate postnatal life support born in two German tertiary perinatal centres between 1999 and 2003.

METHODS

Children were assessed for cognitive and neurological outcomes at the age of 7-10 years. The test battery included a neurological examination, the Wechsler Intelligence Scale for children (WISC-IV) and the Frostigs Developmental Test of Visual Perception (DTVP-2). Gross motor function was classified according to the GMFCS and functional activity was assessed with the Lincoln Oseretzky Motor Development Scale (LOS KF 18).

RESULTS

Outcome data were available for 79/105 children. 75.9% of the entire study cohort showed no or mild impairment. There was no difference seen between the two gestational age groups. Risk factors for moderate or severe impairment were an intracerebral haemorrhage >II° and/or periventricular leukomalacia or a retinopathy of prematurity >II°. Neither the gestational age (GA) nor the birth weight was associated with long-term outcome.

CONCLUSIONS

Gestational age was not a predictor for long-term impairment of preterm infants born <25 completed weeks' GA. Other prognostic factors should be taken into account for counselling in the grey zone of viability.