title: Determinants of developmental outcomes in a very preterm Canadian cohort.
abstract: OBJECTIVE
  Identify determinants of neurodevelopmental outcome in preterm children.
  
  
  METHODS
  Prospective national cohort study of children born between 2009 and 2011 at <29 weeks gestational age, admitted to one of 28 Canadian neonatal intensive care units and assessed at a Canadian Neonatal Follow-up Network site at 21 months corrected age for cerebral palsy (CP), visual, hearing and developmental status using the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III). Stepwise regression analyses evaluated the effect of (1) prenatal and neonatal characteristics, (2) admission severity of illness, (3) major neonatal morbidities, (4) neonatal neuroimaging abnormalities, and (5) site on neurodevelopmental impairment (NDI) (Bayley-III score < 85, any CP, visual or hearing impairment), significant neurodevelopmental impairment (sNDI) (Bayley-III < 70, severe CP, blind or hearing aided and sNDI or death.
  
  
  RESULTS
  Of the 3700 admissions without severe congenital anomalies, 84% survived to discharge and of the 2340 admissions, 46% (IQR site variation 38%-51%) had a NDI, 17% (11%-23%) had a sNDI, 6.4% (3.1%-8.6%) had CP, 2.6% (2.5%-13.3%) had hearing aids or cochlear implants and 1.6% (0%-3.1%) had a bilateral visual impairment. Bayley-III composite scores of <70 for cognitive, language and motor domains were 3.3%, 10.9% and 6.7%, respectively. Gestational age, sex, outborn, illness severity, bronchopulmonary dysplasia, necrotising enterocolitis, late-onset sepsis, retinopathy of prematurity, abnormal neuroimaging and site were significantly associated with NDI or sNDI. Site variation ORs for NDI, sNDI and sNDI/death ranged from 0.3-4.3, 0.04-3.5 and 0.12-1.96, respectively.
  
  
  CONCLUSIONS
  Most preterm survivors are free of sNDI. The risk factors, including site, associated with neurodevelopmental status suggest opportunities for improving outcomes.
authors.affiliation: Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Anne
authors.identifier: http://orcid.org/0000-0002-6917-0978
authors.initials: A
authors.lastname: Synnes
authors.affiliation: Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada.
authors.forename: Thuy Mai
authors.initials: TM
authors.lastname: Luu
authors.affiliation: Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Moddemann
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paige
authors.initials: P
authors.lastname: Church
authors.affiliation: Department of Pediatrics, University of Western Ontario, London, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Vincer
authors.affiliation: Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Ballantyne
authors.affiliation: McGill University Health Centre, Montréal, Quebec, Canada.
authors.forename: Annette
authors.initials: A
authors.lastname: Majnemer
authors.affiliation: Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Dianne
authors.initials: D
authors.lastname: Creighton
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Junmin
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Reginald
authors.initials: R
authors.lastname: Sauve
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Saroj
authors.initials: S
authors.lastname: Saigal
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Prakesh
authors.initials: P
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shoo K
authors.initials: SK
authors.lastname: Lee
mesh_terms: D002170:Canada / Q000453:epidemiology; D002547:Cerebral Palsy / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005865:Gestational Age; D006311:Hearing Disorders / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology
keywords: Outcomes research; impairments; prematurity