[A two-year evaluation of the development of preterm babies born in the region of Warsaw: a prospective cohort study Prematuritas].
OBJECTIVE
Complex evaluation of the development of infants until the end of the second year of life, including neurological and sensory development. A prospective cohort study.


METHODS
1) 264 premature babies born between 24 and 32 weeks of gestation during the period 1st of Oct 1998 and 30th of Sept 1999 in the region of Warsaw. 2) Age of examination at: 4th, 8th and 12th month of postconceptional age and 18th and 24th month of calendar age. 3) Neurological examination according to modified Denver's test, including the development of motor skills, coordination of vision and movement, speech and social contacts. Final division of development into: normal, uncertain and pathological. 4) Cerebral palsy was diagnosed according to the definition and classification proposed by the European Commission in 2002. 5) Retinopathy of prematurity (ROP): back of the eye (Fison's speculum) examination conducted from the 30th day of life, and follow-up depending of the escalation of changes. In cases of diagnosed ROP, stage 3 or 4 laser photocoagulation was performed. 6) Hearing examination: behavioral evaluation, in cases of uncertain or abnormal results ABR (auditory brain stem response) was carried out.


RESULTS
162 children participated in the examination at the age of 2, which comprises 87% of the study population. While evaluating motor and sensory development of study population at 2 years of age, normal development was seen among 88% of children, cerebral palsy of different types (with majority of serious cases) was diagnosed in 8% of children and 2 children were blind. Uncertain development was stated for 4% of children, and 1 of them was deaf. 20% of children experienced delay in speech development and hyperactivity. Among babies born before 28th week of gestational age, 2-3 times higher percentage of 3rd stage of retinopathy of prematurity (ROP) was stated in comparison with developed countries. Nevertheless, no case of blindness was observed in this group of children, which may prove effective screening and effective therapy. At the same time 65% of children with 3rd stage ROP have some problems with vision (squint, short sightedness). The incidence of bronchopulmonary dysplasia-BPD (16%) and chronic lung disease (CLD) (11%) were relatively low. However, the percentage of hospitalization among children with CLD under the age of 2, which was caused by respiratory problems, was 37% compared to 28% of children in which CLD was not diagnosed.


CONCLUSIONS
1) The incidence of cerebral palsy in our study is not different from the results of other authors and was the highest among babies born before 29 weeks of gestation. 2) In the cerebral palsy group, higher incidence of tetraplegia was found, which may be connected with higher prevalence of hemorrhagic changes (IVH grade III or IV) and hypoxic -- ischaemic changes (PVL). 3) A relationship was found between cranial ultrasound (US) at 40 weeks of postconceptional age after PLV and the child's motor development at 2 years of age: normalization in the US was connected with correct development. 4) Incidence of ROP grade 3 was stated to be three times higher compared to other authors. No case of blindness was stated, which proves effectiveness of screening and treatment procedures. 5) Only one case of deafness due to congenital malformation was found. 6) The incidence of bronchopulmonary dysplasia (BPD) and chronic lung disease (CLD) was comparable to data from developed countries. However, the percentage of hospitalization for all respiratory problems among children with CLD under the age of 2 was twice as high as in the remaining population. 7) Developmental disorders such as: hyperactivity, delay of speech and vision problems (strabismus and short sightedness) indicate the need for continued evaluation of this group of children up to school age (5-7).
Klinika Neonatologii i Intensywnej Terapii, Instytut Matki i Dziecka, ul. Kasprzaka 17a, 01-211 Warszawa, Poland.
Magdalena
M
Rutkowska
Ewa
E
Helwich
Katarzyna
K
Szamotulska
Maria
M
Rudzińska-Chazan
Zofia
Z
Kułakowska
Aneta
A
Jeziorek
Małgorzata
M
Seroczyńska
Ewa
E
Nowakowska-Szyrwińska
Anna
A
Romaniuk-Doroszewska
D002547:Cerebral Palsy / Q000453:epidemiology; D015331:Cohort Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D015997:Neonatal Screening / Q000706:statistics & numerical data; D011044:Poland / Q000453:epidemiology; D011159:Population Surveillance; D011446:Prospective Studies; D011782:Quadriplegia / Q000453:epidemiology; D012178:Retinopathy of Prematurity / Q000453:epidemiology