Prevalence and risk factors for neurodevelopmental impairment in very preterm infants without severe intraventricular hemorrhage or periventricular leukomalacia.

OBJECTIVES

To review the prevalence and risk factors for severe neurodevelopmental impairment (NDI) in infants born at 22-29 weeks of gestation without severe intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL).

STUDY

DESIGN

This single-centered retrospective cohort study enrolled infants born at 22-29 weeks of gestation treated at Saitama Medical Center, Saitama Medical University, from 2005 to 2020. Patients with severe IVH or PVL were excluded. The primary outcome was severe NDI at 3 years of age, defined by the presence of neurodevelopmental delay (developmental quotient <70), severe cerebral palsy, or severe sensory deficit. The incidence of severe NDI was assessed, and its associated risk factors were analyzed using multivariable logistic regression.

RESULTS

A total of 666 patients were analyzed, including 134 (20 %) who developed severe NDI. The prevalence of severe NDI was high among infants born at 22 weeks (19/26, 73 %) and 23 weeks (17/50, 34 %) of gestation. A multivariable logistic regression analysis with previously known predictors showed that lower birth weight, male sex, no antenatal corticosteroid therapy, and abdominal surgery were independently associated with severe NDI at 3 years of age.

CONCLUSIONS

As shown in previous studies, a high prevalence of severe NDI was observed in our cohort. Infants born at 22 and 23 weeks of gestation have a high risk of severe NDI even though they are without severe IVH or PVL. Antenatal corticosteroid therapy were beneficial for preventing severe NDI. Infants with a history of abdominal surgery require close monitoring for their neurodevelopmental outcomes.