Neonatal morbidities and developmental delay in moderately preterm-born children.
OBJECTIVE
Children born moderately preterm (32-35(6/7) weeks' gestation) are at increased risk of both neonatal morbidities and developmental delays in early childhood. It is unknown whether neonatal morbidities contribute to the increased risk of developmental delay. The objective of this study was to determine the effect of neonatal morbidities after moderately preterm birth on development at preschool age.


METHODS
In a community-based, stratified cohort, parents of 832 moderately preterm children born in 2002 or 2003 completed the Ages and Stage Questionnaire when their child was 43 to 49 months old. Data on Apgar scores, asphyxia, tertiary NICU admission, hospital transfer, circulatory insufficiency, hypoglycemia, septicemia, mechanical ventilation, continuous positive airway pressure, apneas, caffeine treatment, and hyperbilirubinemia were obtained from medical records. We assessed associations of neonatal characteristics with developmental delay, adjusted for gender, small-for-gestational-age status, gestational age, and maternal education.


RESULTS
Hypoglycemia and asphyxia were associated with developmental delay; odds ratios (ORs) were 2.42 (95% confidence interval [CI]: 1.23-4.77) and 3.18 (95% CI: 1.01-10.0), respectively. Tertiary NICU admission and hyperbilirubinemia had positive but statistically borderline nonsignificant associations with developmental delay: ORs were 1.74 (95% CI: 0.96-3.15) and 1.52 (95% CI: 0.94-2.46), respectively. No other neonatal morbidities were associated with developmental delay. In multivariate analyses, only hypoglycemia was associated with developmental delay (OR: 2.19; 95% CI: 1.08-4.46).


CONCLUSIONS
In moderately preterm-born children, only hypoglycemia increased the risk of developmental delay at preschool age. A concerted effort to prevent hypoglycemia might enhance developmental outcome in this group.
Division of Neonatology, Beatrix Children's Hospital, University Medical Center, University of Groningen, Groningen, Netherlands. j.m.kerstjens@umcg.nl
Jorien M
JM
Kerstjens
Inger F
IF
Bocca-Tjeertes
Andrea F
AF
de Winter
Sijmen A
SA
Reijneveld
Arend F
AF
Bos
D001238:Asphyxia Neonatorum / Q000175:diagnosis / Q000453:epidemiology; D002675:Child, Preschool; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000175:diagnosis / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D005865:Gestational Age; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology*; D007236:Infant, Small for Gestational Age; D007363:Intensive Care Units, Neonatal; D007567:Jaundice, Neonatal / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D011795:Surveys and Questionnaires