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Study Reveals Correlation between Neonatal and Early Childhood Outcomes among Children Delivered Preterm

In a study to be presented on Feb. 6 at 3:15 p.m. CST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in New Orleans, researchers will report on a correlation between initial neonatal and early childhood outcomes among children delivered less than 34 weeks gestation.

Preterm babies are at high risk for death and other serious medical complications, and some premature infants continue to experience side effects from prematurity even during later childhood. It’s uncertain whether preterm babies diagnosed with intestinal problems, severe respiratory problems, bleeding in their brains, and other complications during their stay in the newborn intensive care unit (NICU) after birth will continue to have complications when examined later in childhood.

This study examined more than 1,700 babies who were born prematurely at less than 34 weeks gestation. It then followed babies after they were discharged from the NICU and re-evaluated them as 2-year-olds for evidence of cerebral palsy and neurologic impairment.

Results revealed that about one in five babies who appeared healthy at the time of hospital discharge had cerebral palsy or neurologic impairment at 2 years of age. Further, one in three babies who had one or more serious complications during their NICU stay also had these complications.

“Babies delivered preterm are at high risk for complications as newborns and also later in childhood,” said Tracy Manuck, M.D., one of the researchers and co-director of the University of Utah Prematurity Prevention Clinic. “We found that babies who had serious complications in the newborn intensive care unit were more likely to have cerebral palsy or neurologic impairment in early childhood, but not necessarily. The converse is also true, as about one in five babies who appeared healthy at the time of hospital discharge had complications in early childhood. Early childhood evaluation and interventions should not be withheld from seemingly healthy previous preterm children.”

However, Manuck noted that the relationship between serious NICU complications and serious neurologic impairment in early childhood was not perfect, as the NICU complications were only moderately predictive of prognosis later in childhood.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below.  For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell), or Meghan Blackburn at Meghan@bendurepr.com, 540-687-5099 (office) or 859-492-6303 (cell).

 

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine.  The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed.  For more information visit www.smfm.org.

Abstract 35: Correlation Between Initial Neonatal and Early Childhood Outcomes Among Children Delivered <34 Weeks Gestation

Authors: Tracy Manuck1, Xiaoming Sheng2, Bradley Yoder2, Michael Varner1

1University of Utah, Obstetrics and Gynecology, Salt Lake City, UT, 2University of Utah, Pediatrics, Salt Lake City, UT

Objective: Obstetric researchers commonly use neonatal morbidities as surrogate endpoints for longer-term outcomes. We sought to correlate neonatal diagnoses prior to hospital discharge with early childhood cognitive and motor function.

Study Design: Secondary analysis of a multicenter RCT of antenatal magnesium sulfate (Mg) vs. placebo administered to women at imminent risk for early PTB to prevent death and cerebral palsy (CP) in their offspring. All women were at high risk for PTB <32.0 wks. Singletons delivered 24.0-33.9 wks who survived to hospital discharge post-birth and had 2-year-old outcome data were included. Those surviving to age 2 were assessed by trained physicians and Bayley Scales of Infant Development Mental Development and Psychomotor Development Indices (MDI, PDI). Neonatal diagnoses at each baby’s initial hospital discharge were examined singly and in combination to determine those most predictive of severe composite childhood morbidity, defined as a childhood diagnosis of moderate/severe CP and/or Bayley MDI and/or PDI scores >2 SD below the mean. Data were analyzed by multiple logistic regression and area under ROC curves (AUC).

Results: 1400 children met criteria. Children were delivered at a mean of 29.9 (range: 24.0-33.9) wks gestation. 58 (4.1%) had moderate/severe CP. On Bayley testing, 245 (19.2%) had a MDI Score >2 SD and 229 (17.8%) a PDI Score >2SD below the mean. A total of 349 (24.9%) had severe composite childhood morbidity. Multivariable regression results demonstrating the relationship between neonatal diagnoses and severe childhood morbidity are shown in the Table.

Conclusion: Approximately 1 in 4 children born <34 weeks had severe childhood morbidity at age 2. Individual neonatal morbidities (BPD, NEC, sepsis, severe IVH, and PVL) had modest predictive value for subsequent adverse early childhood outcomes; combinations of multiple morbidities were only marginally more prognostic. Prediction of childhood outcomes from neonatal diagnoses remains imperfect.

Multivariable regression results. Relationship between neonatal diagnoses and the probability of severe composite childhood morbidity are shown. All models are shown for individual predictors; the best model is shown for the combination of 2, 3, and 4 neonatal morbidities. * brain injury = severe intraventricular hemorrhage and/or periventricular leukomalacia  Other co-variables in regression models included delivery gestational age, maternal education, randomization to magnesium, and chorioamnionitis.

Multivariable regression results. Relationship between neonatal diagnoses and the probability of severe composite childhood morbidity are shown. All models are shown for individual predictors; the best model is shown for the combination of 2, 3, and 4 neonatal morbidities.
* brain injury = severe intraventricular hemorrhage and/or periventricular leukomalacia
Other co-variables in regression models included delivery gestational age, maternal education, randomization to magnesium, and chorioamnionitis.

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