Predicting neurosensory disabilities at two years of age in a national cohort of extremely premature infants.
BACKGROUND
Extreme prematurity carries a high risk of neurosensory disability.


OBJECTIVE
Examine which information obtained pre-, peri- and postnatally may be predictive of neurosensory disabilities at 2 years of age.


METHODS
Prospective observational study of all infants born in Norway in 1999 and 2000 with gestational age (GA) 22-27 completed weeks or birth weight (BW) of 500-999 g.


METHODS
Incidence of neurosensory disabilities.


RESULTS
Of 373 surviving children, 30 (8%) had major neurosensory disabilities (26 CP, 6 blind, 3 deaf), and a further 46 (12%) had minor visual or hearing disabilities. The rate of major neurosensory disabilities was 19 of 99 (19%) for children with GA 23-25 vs. 8 of 189 (4%) for GA 26-27 weeks (p<0.001). In a multivariable model, only morbidities detected in the neonatal intensive care unit (NICU) were associated with major neurosensory disabilities; adjusted odds ratios (95% confidence intervals) were 68.6 (18.7, 252.2) for major abnormalities on cerebral ultrasound, 6.8 (1.7, 27.4) for retinopathy of prematurity (ROP) grade>2, 3.2 (1.0, 9.7) for ROP grade 1-2, 6.5 (1.9, 22.3) for prolonged use (> or = 21 days) of steroid treatment for lung disease and 3.1 (1.0, 9.4) for clinical chorioamnionitis. The visual outcome was strongly related to the degree of ROP (p<0.001), and all who had a normal hearing screen in the NICU had normal hearing at 2 years.


CONCLUSIONS
NICU morbidities, rather than GA or intrauterine growth are the significant predictors of major neurosensory disabilities among extreme prematurity surviving to discharge from the NICU.
Leversen
Katrine Tyborg
KT
Department of Clinical Medicine, University of Bergen, Bergen, Norway. ktle@helse-bergen.no
Sommerfelt
Kristian
K
Rønnestad
Arild
A
Kaaresen
Per Ivar
PI
Farstad
Theresa
T
Skranes
Janne
J
Støen
Ragnhild
R
Elgen
Irene Bircow
IB
Rettedal
Siren
S
Eide
Geir Egil
GE
Irgens
Lorentz M
LM
Markestad
Trond
T
D002547:Cerebral Palsy / Q000453:epidemiology*; D002675:Child, Preschool; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D016015:Logistic Models; D015233:Models, Statistical; D009664:Norway / Q000453:epidemiology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012178:Retinopathy of Prematurity / Q000453:epidemiology*; D012678:Sensation Disorders / Q000453:epidemiology*