Relationship between attrition and neurodevelopmental impairment rates in extremely preterm infants at 18 to 24 months: a systematic review.
OBJECTIVE
To assess the effect of loss to follow-up rates at 18 to 24 months on neurodevelopmental outcome statistics for infants of less than 1000 g birth weight or less than 28 weeks' gestational age.


METHODS
MEDLINE, EMBASE, PubMed, and Cochrane Library databases (January 1, 2000, to June 30, 2010).


METHODS
We searched for studies reporting outcomes of infants of less than 1000 g birth weight or less than 28 weeks' gestational age who were born after 1990.


METHODS
Eligible articles had to report the primary outcome and follow-up rates at 18 to 24 months.


RESULTS
Our primary composite outcome of neurodevelopmental impairment (NDI) was any of a mental developmental quotient 2 SDs below the mean, using the Bayley Scales of Infant Development II; cerebral palsy; visual impairment; or significant hearing impairment.


RESULTS
Of 43 publications describing outcomes at 18 to 24 months, 20 provided rates of follow-up, describing a total of 34,185 infants. The NDI rates ranged between 12.4% and 57.5%. Follow-up rates ranged between 71.6% and 100%. Higher rates of NDI were significantly correlated with greater loss to follow-up (r(2) = 0.38, P = .007). Higher rates of both NDI and loss to follow-up were seen in the United States compared with Canada, the United Kingdom, Finland, Denmark, Austria, Germany, and Australia (r(2) = 0.70, P = .001).


CONCLUSIONS
Ascertainment bias may overestimate NDI in extremely low-birth-weight or extremely low-gestational-age survivors at 18 to 24 months. Alternatively, the characteristics of different populations and health systems may contribute to higher rates of attrition and higher rates of NDI.
Division of Neonatology, The Children's Hospital of Philadelphia, PA 19104, USA.
Ursula
U
Guillén
Sara
S
DeMauro
Li
L
Ma
John
J
Zupancic
Robin
R
Roberts
Barbara
B
Schmidt
Haresh
H
Kirpalani
D002547:Cerebral Palsy / Q000453:epidemiology; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology; D006311:Hearing Disorders / Q000453:epidemiology; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology; D059012:Lost to Follow-Up; D014786:Vision Disorders / Q000453:epidemiology; D014792:Visual Acuity