title: Younger gestational age is associated with increased risk of adverse neurodevelopmental outcome during infancy in congenital diaphragmatic hernia.
abstract: BACKGROUND
  The purpose of the study was to investigate the impact of gestational age (GA) on short-term neurodevelopmental (ND) outcomes in congenital diaphragmatic hernia survivors.
  
  
  METHODS
  Between 6/2004 and 2/2013, 135 consecutive CDH patients underwent ND assessment using the Bayley Scales of Infant Development-III at a median follow-up age of 13months (range, 5-36). ND delay was defined by a score of ≤85 in any of the composite scales. Severe impairment was defined as a score of ≤69 in at least one domain. The effect of GA was evaluated as continuous and categorical variables. GA at delivery was grouped into full term (39-41weeks), near term (37-38), late preterm (34-36), and preterm (24-33).
  
  
  RESULTS
  Median GA at delivery was 38weeks (range, 24-41). Fifty (37%) patients were delivered full term, 59 (44%) near term, 16 (12%) late preterm, and 10 (7%) preterm. CDH children born before 39weeks' gestation were more likely to score below average (P=0.005) with corrected age for at least one composite score compared to full term peers. Cognitive (P=0.06) and language (P=0.08) scores tended to be lower in the near-term and late-preterm group compared to full-term CDH infants. Patients born near term and late preterm had significantly lower motor composite and fine motor scores compared to full-term children (P=0.009 and P<0.01, respectively). Preterm children scored the lowest in all composite scales (P<0.05).
  
  
  CONCLUSIONS
  Compared to term infants, not only preterm but also late preterm and near-term CDH children carry an increased risk of ND delays. Motor performance appears most susceptible to earlier delivery.
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania School of Medicine, Philadelphia, PA, USA. Electronic address: danzere@email.chop.edu.
authors.forename: Enrico
authors.initials: E
authors.lastname: Danzer
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Marsha
authors.initials: M
authors.lastname: Gerdes
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: D'Agostino
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Judy
authors.initials: J
authors.lastname: Bernbaum
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Casey
authors.initials: C
authors.lastname: Hoffman
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Herkert
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Rintoul
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Peranteau
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Alan W
authors.initials: AW
authors.lastname: Flake
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
authors.affiliation: The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; The University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Holly L
authors.initials: HL
authors.lastname: Hedrick
mesh_terms: D000367:Age Factors; D000704:Analysis of Variance; D002658:Developmental Disabilities / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D016014:Linear Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Bayley scales of infant development; Congenital diaphragmatic hernia; Neurodevelopmental outcome; Preterm; Pulmonary hypoplasia