Impact of neonatal morbidity on the risk of developmental delay in late preterm infants
Introduction
Prematurity, defined as birth before 37 weeks of gestation, represents the greatest risk of morbidity and mortality in newborn infants, where late preterm infants (LPI), born between week 340/7 and 366/7, represent the majority of this population [1], [2]. In developed countries, the rate of prematurity is around 9.6% [3], with LPI representing 70–80% of all premature births. After a progressive increase of LPI in the two past decades, it appears now to be decreasing [3], [4], [5].
The National Institute of Child Health and Human Development (NICHD) issued a consensus document in 2005 on optimizing care in LPI in an attempt to improve outcomes in the short and long term and to decrease the consumption of resources by this population [1]. Complications in LPI are associated with higher costs than newborn infants with a lower gestational age (GA), due to the significant number of births in this stage of gestation [6], [7]. An increased risk of perinatal morbidity has been demonstrated in LPI, with respiratory morbidity the most prevalent [8], [9], [10], [11], [12], [13].
McGowan JE et al., in a review that included 10 studies evaluating LPI between 1 and 7 years of age, found that in all the age groups between 3 and 7 years, the LPI showed worse academic results and increased difficulties in school activities, revealing itself to be a population at risk of adverse neurological development and learning difficulties up to the age of 7 years, compared with term-born children [14].
In several articles, these LPI with perinatal morbidity are called ‘complicated’ (cLPI); they show greater risk of developmental difficulties in some studies [15], [16] whereas this has not been demonstrated in others [17], [18]. Regarding perinatal history, respiratory morbidity, hypoglycaemia, multiple gestations, and being small for gestational age have been related significantly with neurodevelopmental disorders in the LPI population [11], [19], [20]. In a previous study we found a greater prevalence of risk of developmental delay (DD) in LPI compared to term-born infants at the age of 4 years based on the overall performance of ASQ3, but we did not analysed those LPI with or without perinatal morbidity nor did we organized the analysis by domains [21]. For the current study we recruited a larger sample of children with the objectives of: (1) to compare the risk of DD at 4 years of age between LPI who have presence or absence of any morbidity associated with the prematurity at birth, called complicated (cLPI) or uncomplicated (uLPI), and term-born infants, (2) to determine maternal and perinatal factors associated with risk of DD, and (3) to analyze in LPI, the association between perinatal morbidity and risk of DD.
Section snippets
Population
A retrospective cohort study was carried out including 163 LPI (GA of 340/7 to 366/7 weeks) and 158 term-born infants (GA of 370/7 to 416/7 weeks) born in a private hospital of a healthcare insurance company with a Neonatal Intensive Care Unit, from 1 January to 31 December 2009 and 2011. The LPI were classified as complicated (cLPI) when they had any morbidity associated with the prematurity, such as clinical instability, respiratory problems, hyperbilirubinaemia requiring phototherapy, or
Results
Those recruited were 163 LPI: 47 cLPI and 116 uLPI, and 158 terms. The biodemographic, perinatal, and social characteristics of the groups are presented in Table 2. The parents' ages, the rates of caesarean sections and twinning frequency were significantly higher in the LPI compared to the terms, while university education of the father and breast-feeding were lower in the LPI. There were no differences between the two groups in gender or the incidence of IUGR. Of the 163 LPI included in the
Discussion
In this study, the cLPI group had a higher frequency of risk of delay in the communication domain compared to uLPI and term-born infants, and in adjusted analysis, when comparing cLPI with term-born infants, we found a risk of delay in the personal-social domain that was at the limit of significance. However, in other studies, there are differences between groups of cLPI and uLPI in other domains [11], [15], [16]. Our results coincide with the study by Ballantyne M et al., which showed that LPI
Conflict of interest statement
All authors have no personal or financial conflicts of interest to disclose.
Acknowledgements
We are grateful to Mireia Corrales for her collaboration in the delivery, counselling, and collection of questionnaires at the homes of parents, and Ivan Armijo for his advice in the methodological analysis.
References (33)
- et al.
Changes in the gestational age distribution among US. Singleton births: impact on rates of late preterm birth, 1992 to 2002
Semin. Perinatol.
(2006) - et al.
Division of vital statistics, births: final data for 2015
Natl. Vital Stat. Rep.
(2017) - et al.
Epidemiology of late and moderate preterm birth
Semin. Fetal Neonatal Med.
(2012) - et al.
Visuospatial and verbal fluency relative deficits in 'complicated' late-preterm preschool children
Early Hum. Dev.
(2009) - et al.
Cognitive deficit in preschoolers born late-preterm
Early Hum. Dev.
(2011) - et al.
Neonatal intensive care and late preterm infants: health and family functioning at three years
Early Hum. Dev.
(2014) - et al.
Association between neonatal morbidity, gestational age and developmental delays in moderate to late preterm children
Rev. Chil. Pediatr.
(2015) - et al.
Development deficit risk in the late premature newborn: evaluation at 48 months using the Ages & Stages Questionnaires®
An. Pediatr. (Barc.)
(2016) - et al.
Risk of developmental delay: comparison of late preterm and full term Canadian infants at age 12 months
Early Hum. Dev.
(2016) The “Late preterm” birth—ten years later
Pediatrics
(2017)
Are preterm births on the decline in the United States? Recent data from the National Vital Statistics System
NCHS Data Brief
Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study
Arch. Dis. Child. Fetal Neonatal Ed.
Optimizing care outcomes for late preterm neonates
Curr Treat Options Peds
Risk factors associated with respiratory disorders in late preterm infants
J. Matern. Fetal Neonatal Med.
A prospective study of the severity of early respiratory distress in late preterms compared to term infants
J. Matern. Fetal Neonatal Med.
Short-and- long-term outcomes of moderate and late preterm infants
Am. J. Perinatol.
Cited by (15)
Neurodevelopmental outcome of late-preterm infants: Literature review
2019, Archives de PediatrieCitation Excerpt :A significant increase of neurodevelopmental delay was observed in infants with a complex neonatal course. Surprisingly, LPIs with an easy neonatal course exhibited as identical neurological performance to full-term infants [19]. In a moderate- and late-preterm cohort, neonatal hypoglycaemia (OR = 2.42, 95% CI [1.23–4.77]) and Apgar scores of less than 7 at 5 min (OR = 3.18, 95% CI [1.01–10]) were associated with a global ASQ score more than -2 SD in univariate analysis.
Neurodevelopmental outcomes of the late preterm infant
2019, Seminars in Fetal and Neonatal MedicineCitation Excerpt :In one study performed in Spain, the complicated LPI group had a higher risk of delay in the communication domain compared to uncomplicated LPI and FTI using the Ages and Stages Questionnaire (ASQ)-3. Complicated LPI compared to FTI also had a risk of delay in the personal–social domain [13]. Another study similarly showed that LPI who require admission to the NICU have increased risk of developmental delay as measured with the ASQ-3, especially in the communication domain [14].
Reliability and agreement of ages and stages questionnaires®: Results in late preterm and term-born infants at 24 and 48 months
2019, Early Human DevelopmentCitation Excerpt :The follow up at 48 months was chosen based in fact that this age is considered the last step for the detection of subtle delays that can benefit from intervention [26]. In our previous studies it was shown that the ASQ-3 allowed for the identification of those at risk [27,28], however, no reliability studies for the ASQ-3 had been carried out in this population. In addition, few studies have analyzed the effects of biological risk factors, such as premature birth, on the psychometric properties of the test and on the developmental pathways of the children.
Late preterm: A population at risk
2018, Clinica e Investigacion en Ginecologia y ObstetriciaAcademic performance in moderately and late preterm children in the United States: are they catching up?
2024, Journal of Perinatology