Evaluation of Survival and Neurodevelopmental Outcomes in Neonates Born Very Preterm

Abstract

Preterm infants are a vulnerable population at high risk for mortality, morbidity, and neurodevelopmental impairments that carry lifelong consequences. Knowledge of survival and sequelae by gestational age is of great importance in order to be able to guide parents and health professionals. The aim of this study is to evaluate perinatal morbidity, mortality and neurodevelopment impairment by gestational age (GA) and analyze the impact of perinatal factors on neurodevelopment outcomes of very preterm (VPT) infants. We conducted a retrospective cohort study off all infants born with < 32 weeks of GA, admitted to the Neonatal Intensive Care Unit in a tertiary maternity hospital from 2013 to 2021. Neurodevelopment was assessed at 24 months of post-menstrual-age, using Griffiths Mental Developmental Scales II (GMDS-II). Moderate to severe neurodevelopment impairment (NDI) was considered in the presence of at least one of the following: global development quotient GMDS-II < 70, cerebral palsy (CP), severe visual impairment or profound sensorineural deafness. There were 311 VPT infants assessed for eligibility, 38 (10.9%) neonatal deaths and 37 (11.9%) losses to follow-up. Neurodevelopment evaluation was performed in 274 infants, 6.2% had moderate to severe NDI. GMDS-II global score < 70 was verified in 4.7%. CP was diagnosed in 3.3%, profound sensorineural deafness in 0.7% and severe visual impairment in 0.7%. The survival and survival without NDI were inversely related to GA. At 25 weeks of GA the survival rate without sequelae exceeded deaths and from 29 weeks the survival rate without NDI was ≥ 88%. In multivariate logistic regression analysis, GA was a protective factor for moderate to severe NDI or death (aOR 0.66; CI 95% 0.46–0.95), whereas being male (aOR 3.43; CI 95% 1.62–7.23) and resuscitation with tracheal intubation (aOR 6.36; CI 95% 2.90-13.59) were independent risk factors. Gestational age is the most significant and independent predictor of NDI. This work provides information not only on survival, but also on neurodevelopment in VPT stratified according to GA, and allows us to inform parents and health care professionals of the risks inherent in this population.