title: Early postnatal illness severity scores predict neurodevelopmental impairments at 10 years of age in children born extremely preterm.
abstract: A neonatal illness severity score, The Score for Neonatal Acute Physiology-II (SNAP-II), predicts neurodevelopmental impairments at two years of age among children born extremely preterm. We sought to evaluate to what extent SNAP-II is predictive of cognitive and other neurodevelopmental impairments at 10 years of age.
  
  
  
  In a cohort of 874 children born before 28 weeks of gestation, we prospectively collected clinical, physiologic and laboratory data to calculate SNAP-II for each infant. When the children were 10 years old, examiners who were unaware of the child's medical history assessed neurodevelopmental outcomes, including neurocognitive, gross motor, social and communication functions, diagnosis and treatment of seizures or attention deficit hyperactivity disorder (ADHD), academic achievement, and quality of life. We used logistic regression to adjust for potential confounders.
  
  
  
  An undesirably high SNAP-II (⩾30), present in 23% of participants, was associated with an increased risk of cognitive impairment (IQ, executive function, language ability), adverse neurological outcomes (epilepsy, impaired gross motor function), behavioral abnormalities (attention deficit disorder and hyperactivity), social dysfunction (autistic spectrum disorder) and education-related adversities (school achievement and need for educational supports. In analyses that adjusted for potential confounders, Z-scores ⩽-1 on 11 of 18 cognitive outcomes were associated with SNAP-II in the highest category, and 6 of 18 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals ranged from 1.4 (1.01, 2.1) to 2.1 (1.4, 3.1). Similarly, 2 of the 8 social dysfunctions were associated with SNAP-II in the highest category, and 3 of 8 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals were slightly higher for these assessments, ranging from 1.6 (1.1, 2.4) to 2.3 (1.2, 4.6).
  
  
  
  Among very preterm newborns, physiologic derangements present in the first 12 postnatal hours are associated with dysfunctions in several neurodevelopmental domains at 10 years of age. We are unable to make inferences about causality.
authors.affiliation: Department of Pediatrics and Neonatology, Nationwide Children's Hospital, and The Ohio State University, Columbus, OH, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Logan
authors.affiliation: Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.|Perinatal Neuroepidemiology Unit, Hannover Medical School, Hannover, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Dammann
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Boston Children's Hospital, Boston, MA, USA.
authors.forename: E N
authors.initials: EN
authors.lastname: Allred
authors.affiliation: Department of Pediatrics and Neonatology, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Dammann
authors.affiliation: Department of Pediatrics and Neonatology, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: K
authors.initials: K
authors.lastname: Beam
authors.affiliation: Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Joseph
authors.affiliation: Department of Pediatrics and Neonatology, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: O'Shea
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Boston Children's Hospital, Boston, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Leviton
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, Boston University School of Medicine, Boston, MA, USA.
authors.forename: K C K
authors.initials: KCK
authors.lastname: Kuban
mesh_terms: D002648:Child; D002657:Child Development; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000503:physiopathology; D056344:Executive Function; D005260:Female; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature / Q000254:growth & development*; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D014481:United States