Current status of neurodevelopmental outcomes and its influencing factors of early-to-moderate preterm infants at corrected age of 18 months

doi:10.3969/j.issn.1674-8115.2023.04.006

Abstract

Abstract:

Objective ·To analyze the neurodevelopmental outcomes and risk factors of early-to-moderate preterm infants with gestational age≤34 weeks at corrected age of 18 months. Methods ·The early-to-moderate preterm infants hospitalized in Neonatal Intensive Care Unit of Shanghai Children's Hospital from January 2013 to April 2020, and regularly followed up after discharge were included in this study. Demographic and clinically relevant data of preterm infants and their parents were collected. The infants were divided into the neurodevelopmental retardation group and the normal neurodevelopment group according to their Gesell Development Schedule (GDS) scores at corrected age of 18 months. The demographic characteristics of preterm infants, birth status, demographic characteristics of parents and prenatal examinations between the two groups were compared, and stepwise Logistic regression was used to explore the factors influencing neurodevelopmental outcomes in preterm infants. Results ·A total of 929 preterm infants were included in the study, including 527 boys (56.7%) and 402 girls (43.3%), with a mean gestational age of (31.06±2.23) weeks and 138 (14.9%) extremely preterm infants. A total of 147 infants (15.8%) had neurodevelopmental retardation of early-to-moderate preterm infants at corrected age of 18 months, with abnormalities of 7.4%, 9.7%, 17.9%, 14.2% and 13.7% in gross motor, fine motor, language, adaptive behavior and personal-social behavior, respectively. A comparison of the clinical characteristics between the neurodevelopmental retardation group and the normal neurodevelopment group revealed statistically significant differences in terms of gender, whether the baby was an extremely preterm infant, birth weight, mode of delivery, and occurrence of intrauterine distress (all P<0.05). Stepwise Logistic regression analysis showed that boys (OR=1.60, 95%CI 1.05?2.44, P=0.028), cesarean section (OR=1.67, 95%CI 1.08?2.60, P=0.022), extremely preterm infants (OR=2.20, 95%CI 1.34?3.62, P=0.002) and intrauterine distress (OR=5.03, 95%CI 2.11?11.99, P=0.000) were the risk factors for neurodevelopmental retardation. Conclusion ·Boys, extremely preterm infants, cesarean section and intrauterine distress may increase the neurodevelopmental retardation risk of early-to-moderate preterm infants and improving follow-up management of these preterm infants should be focused on and enhanced.

Key words: preterm infant, neurodevelopment, neurodevelopmental retardation, risk factor, Gesell Development Schedule

CLC Number:

R722.6

SHEN Li, HUANG Hengye, YU Guangjun. Current status of neurodevelopmental outcomes and its influencing factors of early-to-moderate preterm infants at corrected age of 18 months[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(4): 445-452.

Figures/Tables 5

TrendMD

References 37

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Variable	Total (n=929)	Normal neurodevelopment group (n=782)	Neurodevelopmental retardation group (n=147)	t/z/χ² value	P value
Gender/n(%)				8.023	0.005
Boy	527 (56.7)	428 (54.7)	99 (67.3)
Girl	402 (43.3)	354 (45.3)	48 (32.7)
Gestational age/week	31.06±2.23	31.10±2.18	30.81±2.46	1.211	0.140
Extremely preterm infant/n(%)	138 (14.9)	107 (13.7)	31 (21.1)	5.365	0.021
Birth weight/kg	1.61 (1.32, 1.91)	1.64 (1.35, 1.93)	1.50 (1.24, 1.80)	2.412	0.016
Birth weight/n(%)				3.518	0.172
Normal birth weight	40 (4.3)	33 (4.2)	7 (4.8)
Low birth weight	439 (47.3)	381 (48.7)	58 (39.5)
Extremely low birth weight	303 (32.6)	248 (31.7)	55 (37.4)
Missing	147 (15.8)	120 (15.3)	27 (18.4)
Body length/cm	42.0 (39.0, 44.8)	42.0 (39.0, 45.0)	42.0 (38.0, 44.0)	1.298	0.194
Delivery mode/n(%)				13.211	0.000
Vaginal delivery	709 (76.3)	614 (78.5)	95 (64.6)
Cesarean delivery	220 (23.7)	168 (21.5)	52 (35.4)
Intrauterine distress/n(%)	24 (2.6)	13 (1.7)	11 (7.5)	16.658	0.000
Respiratory failure of newborn/n(%)	237 (25.5)	191 (24.4)	46 (31.3)	3.071	0.080
Apnea of newborn/n(%)	83 (8.9)	70 (9.0)	13 (8.8)	0.002	0.966
Pneumonia of newborn/n(%)	308 (33.2)	260 (33.2)	48 (32.7)	0.020	0.888
Purulent meningitis of newborn/n(%)	40 (4.3)	35 (4.5)	5 (3.4)	0.347	0.556
Hyperbilirubinemia of newborn/n(%)	447 (48.1)	374 (47.8)	73 (49.7)	0.167	0.683

Variable	Total (n=929)	Normal neurodevelopment group (n=782)	Neurodevelopmental retardation group (n=147)	t/z/χ² value	P value
Gender/n(%)				8.023	0.005
Boy	527 (56.7)	428 (54.7)	99 (67.3)
Girl	402 (43.3)	354 (45.3)	48 (32.7)
Gestational age/week	31.06±2.23	31.10±2.18	30.81±2.46	1.211	0.140
Extremely preterm infant/n(%)	138 (14.9)	107 (13.7)	31 (21.1)	5.365	0.021
Birth weight/kg	1.61 (1.32, 1.91)	1.64 (1.35, 1.93)	1.50 (1.24, 1.80)	2.412	0.016
Birth weight/n(%)				3.518	0.172
Normal birth weight	40 (4.3)	33 (4.2)	7 (4.8)
Low birth weight	439 (47.3)	381 (48.7)	58 (39.5)
Extremely low birth weight	303 (32.6)	248 (31.7)	55 (37.4)
Missing	147 (15.8)	120 (15.3)	27 (18.4)
Body length/cm	42.0 (39.0, 44.8)	42.0 (39.0, 45.0)	42.0 (38.0, 44.0)	1.298	0.194
Delivery mode/n(%)				13.211	0.000
Vaginal delivery	709 (76.3)	614 (78.5)	95 (64.6)
Cesarean delivery	220 (23.7)	168 (21.5)	52 (35.4)
Intrauterine distress/n(%)	24 (2.6)	13 (1.7)	11 (7.5)	16.658	0.000
Respiratory failure of newborn/n(%)	237 (25.5)	191 (24.4)	46 (31.3)	3.071	0.080
Apnea of newborn/n(%)	83 (8.9)	70 (9.0)	13 (8.8)	0.002	0.966
Pneumonia of newborn/n(%)	308 (33.2)	260 (33.2)	48 (32.7)	0.020	0.888
Purulent meningitis of newborn/n(%)	40 (4.3)	35 (4.5)	5 (3.4)	0.347	0.556
Hyperbilirubinemia of newborn/n(%)	447 (48.1)	374 (47.8)	73 (49.7)	0.167	0.683

Variable	Total (n=929)	Normal neurodevelopment group (n=782)	Neurodevelopmental retardation group (n=147)	z/χ² value	P value
Maternal age/year	31.0 (28.0, 34.0)	31.0 (28.0, 34.0)	31.0 (28.0, 34.0)	0.161	0.872
Parental smoking^①/n(%)	179 (19.3)	145 (18.5)	34 (23.1)	1.674	0.196
Maternal alcohol consumption/n(%)	4 (0.4)	4 (0.5)	0 (0)	0.755	0.855
Father's chronic illness/n(%)	33 (3.6)	25 (3.2)	8 (5.4)	1.821	0.177
Mother's chronic illness/n(%)	43 (4.6)	34 (4.3)	9 (6.1)	0.883	0.347
Gestational hypertension/n(%)	48 (5.2)	37 (4.7)	11 (7.5)	1.912	0.167
Gestational diabetes mellitus/n(%)	95 (10.2)	76 (9.7)	19 (12.9)	1.386	0.239
Thyroid disease during pregnancy/n(%)	44 (4.7)	33 (4.2)	11 (7.5)	2.920	0.087
Anemia during pregnancy/n(%)	36 (3.9)	27 (3.5)	9 (6.1)	2.368	0.124
Placenta previa/n(%)	15 (1.6)	14 (1.8)	1 (0.7)	0.388	0.533
Abruptio placentae/n(%)	9 (1.0)	9 (1.2)	0 (0)	0.719	0.396
Abnormal fetal position/n(%)	5 (0.5)	5 (0.6)	0 (0)	0.128	0.721
Number of prenatal tests≥8/n(%)	363 (39.1)	307 (39.3)	56 (38.1)	0.070	0.791
Tertiary hospital maternity examination/n(%)	401 (43.2)	331 (42.3)	70 (47.6)	1.412	0.235

Variable	Total (n=929)	Normal neurodevelopment group (n=782)	Neurodevelopmental retardation group (n=147)	z/χ² value	P value
Maternal age/year	31.0 (28.0, 34.0)	31.0 (28.0, 34.0)	31.0 (28.0, 34.0)	0.161	0.872
Parental smoking^①/n(%)	179 (19.3)	145 (18.5)	34 (23.1)	1.674	0.196
Maternal alcohol consumption/n(%)	4 (0.4)	4 (0.5)	0 (0)	0.755	0.855
Father's chronic illness/n(%)	33 (3.6)	25 (3.2)	8 (5.4)	1.821	0.177
Mother's chronic illness/n(%)	43 (4.6)	34 (4.3)	9 (6.1)	0.883	0.347
Gestational hypertension/n(%)	48 (5.2)	37 (4.7)	11 (7.5)	1.912	0.167
Gestational diabetes mellitus/n(%)	95 (10.2)	76 (9.7)	19 (12.9)	1.386	0.239
Thyroid disease during pregnancy/n(%)	44 (4.7)	33 (4.2)	11 (7.5)	2.920	0.087
Anemia during pregnancy/n(%)	36 (3.9)	27 (3.5)	9 (6.1)	2.368	0.124
Placenta previa/n(%)	15 (1.6)	14 (1.8)	1 (0.7)	0.388	0.533
Abruptio placentae/n(%)	9 (1.0)	9 (1.2)	0 (0)	0.719	0.396
Abnormal fetal position/n(%)	5 (0.5)	5 (0.6)	0 (0)	0.128	0.721
Number of prenatal tests≥8/n(%)	363 (39.1)	307 (39.3)	56 (38.1)	0.070	0.791
Tertiary hospital maternity examination/n(%)	401 (43.2)	331 (42.3)	70 (47.6)	1.412	0.235

Abnormality	Total (n=929)	Normal neurodevelopment group (n=782)	Neurodevelopmental retardation group (n=147)	χ² value
Gross motor/n(%)	69 (7.4)	20 (2.6)	49 (33.3)	170.455
Fine motor/n(%)	90 (9.7)	19 (2.4)	71 (48.3)	297.568
Language/n(%)	166 (17.9)	80 (10.2)	86 (58.5)	196.481
Adaptive behavior/n(%)	132 (14.2)	33 (4.2)	99 (67.3)	404.518
Personal-social behavior/n(%)	127 (13.7)	31 (4.0)	96 (65.3)	394.527