Outcome at 3 years of age in a population-based cohort of extremely preterm infants.
OBJECTIVE
To assess health and neurodevelopmental outcome at 3 years of age in neonatal intensive care unit (NICU)-surviving children who were born at 26 or fewer weeks of gestation in a geographically defined region of Belgium from 1999 through 2000.


METHODS
The study included a clinical examination and a standardized neurologic and developmental assessment. Disabilities were defined by international criteria. In 97% (92 of 95) of the children, accurate information on the presence of overall disability could be collected.


RESULTS
Thirty-six percent (95% confidence interval [CI] 25-47%) of the formally assessed children (28 of 77) had deficient neuromotor development, with 5% of them showing severe sensory-communicative impairment. Mean (+/-standard deviation) scores on the Mental Developmental Index and Psychomotor Developmental Index were 81.2 (18.8) and 73.2 (17.8), respectively. Seventy percent (95% CI 60-80%) had a mental (Mental Developmental Index) or psychomotor (Psychomotor Developmental Index) impairment or both, assessed to be more than 1 standard deviation below the population mean. Mental and psychomotor outcome did not differ significantly when compared according to either gestational age, gender, or multiple birth (all P>.05). When either minor central dysfunction or cerebral palsy was not taken into account, normal mental development was recorded in 62% of the subjects. The cumulative of poor outcome (ie, disability- or prematurity-related death) among the 95 infants discharged alive was estimated to be 58% (95% CI 48-68%), representing 25 (26%) mildly-to-moderately disabled and 28 (29%) severely disabled toddlers, including two infants whose postdischarge deaths were directly related to prematurity.


CONCLUSIONS
The average developmental outcome is poor in children born as extremely preterm infants. Finding early predictors of adverse outcome is a major challenge.
De Groote
Isabel
I
Research Group Developmental Disabilities, Ghent University, Ghent, Belgium.
Vanhaesebrouck
Piet
P
Bruneel
Els
E
Dom
Lina
L
Durein
Isabelle
I
Hasaerts
Danielle
D
Laroche
Sabine
S
Oostra
Ann
A
Ortibus
Els
E
Roeyers
Herbert
H
van Mol
Christine
C
D001530:Belgium / Q000453:epidemiology; D002657:Child Development / Q000502:physiology*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D009420:Nervous System / Q000254:growth & development*; D009422:Nervous System Diseases / Q000453:epidemiology*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011379:Prognosis