title: The Development of Extremely Premature Infants.
abstract: BACKGROUND
  Until now, there has been no comprehensive long-term study in Germany on the development of extremely premature infants up to school age.
  
  
  METHODS
  From October 2004 to September 2008, in the German federal state of Lower Saxony, 437 infants born at a gestational age less than 28 weeks were followed up at the ages of 2 and 5 years, and some at the age of 10 years. The 5-year follow-up data were collated with the peri- and neonatological parameters and compared with the 2- and 10-year follow-up data.
  
  
  RESULTS
  The mortality of extremely premature infants was 25.1%. Among the five-year-olds studied, 14.1% showed cognitive impairment and 17.4% had cerebral palsy. 40.4% manifested abnormalities of speech or language, 33.1% had behavioral abnormalities, and 72.5% received therapeutic interventions. Infants in whom severe brain damage was diagnosed by ultrasonography shortly after birth were more likely to develop cerebral palsy (odds ratio [OR] 38.28, 99% confidence interval [12.55; 116.80]) and to have impaired cognitive development (OR 7.36 [2.52; 21.51]). The likelihood of cognitive impairment was also higher among infants whose mothers had a lower level of education (OR 3.83 [1.68; 8.77]). 73.1% (242 out of 331) of the two-year-olds were in the same category of cognitive function at the 5-year follow-up; 82.4% (65 out of 79) of the 5-year-olds were in the same category of cognitive function at the 10-year follow-up.
  
  
  CONCLUSIONS
  Many of these extremely premature infants had developmental disturbances, and many required therapeutic interventions. The risk factors revealed by this study may help identify patients who are in particular need of support, enabling targeted measures to be taken at the earliest possible stage in order to improve their cognitive and motor abilities. Nationwide, standardized follow-up at the age of 5 years would be desirable.
authors.affiliation: Sozialpädiatrisches Zentrum (sociopediatric center) Auf der Bult, Hannover, Germany; Sozialpädiatrisches Zentrum, Pediatric Clinic, University Medical Center Göttingen, Germany; Sozialpädiatrisches Zentrum, Children's Hospital Osnabrück, Germany; Sozialpädiatrisches Zentrum, Diakonisches Werk Oldenburg, Germany; Center for Quality and Management in Health Care (ZQ), Medical Association of Lower Saxony, Hannover, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Voss
authors.forename: Elke
authors.initials: E
authors.lastname: Hobbiebrunken
authors.forename: Uta
authors.initials: U
authors.lastname: Ungermann
authors.forename: Michael
authors.initials: M
authors.lastname: Wagner
authors.forename: Gabriele
authors.initials: G
authors.lastname: Damm
mesh_terms: D002547:Cerebral Palsy; D002657:Child Development; D002675:Child, Preschool; D003072:Cognition Disorders; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D005865:Gestational Age; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases; D008297:Male