The advances in neonatology over the past decade and a half have been extraordinary, with dramatic improvements in survival of extremely preterm infants (infants < 27 weeks’ gestation). How is the development of these infants as they get older? Two studies from our June issue address this question.
The first study by Peralta-Carcelen et al. (10.1542/peds.2016-1043) describes a cohort of 2500 extremely preterm infants who were evaluated at 18-22 months for behavioral issues as well as for cognition and language. If you are a “cup half-full” optimist, the results can be read optimistically in that 65% of the infants were doing fine behaviorally and 75 % showed no issues in terms of their socioemotional competence. But if you are a “cup half-empty” pessimist, you could read these results to note that a third of infants had behavioral problems and a quarter had problems with their socioemotional competencies and in turn their cognitive and language functions. The authors evaluate risk factors that lead to the poorer neurodevelopmental outcomes, which you should read for yourself given how relevant these risk factors may be to the patients in your practice.
What happens when these infants reach school age? Cheong et al (10.1542/peds.2016-4086) looked at 3 population –based cohorts of extremely preterm infants from 1991-2, 1997, and 2005 and then tested them at age 8 years for their intelligence, academic achievement, and neurosensory status (evidence of cerebral palsy, blindness or deafness). There was no difference in the level of major neurosensory disability as well as IQ scores across all time periods studied, although academic achievement seemed worse in the 2005 cohort relative to the earlier ones and common risk factors like socioeconomic status or perinatal problems could not explain the decline in achievements. While one might have hoped for improvements in neurosensory care in the setting of the perinatal advancements that lead to more extremely preterm infants surviving, there appears to be more work to be done if we want this population truly thriving.
To add a perspective on these studies, neonatologist and Professor of Pediatrics Dr. Betty Vohr, who specializes in long-term developmental follow-up of high risk preterm infants at Brown, shares a commentary on these studies that summarizes where we are and where we need to be (10.1542/peds.2017-0453). Check out both studies and the commentary and then share the information as needed with your patients whose children fit the category of having been born extremely preterm so they are as well informed of the developmental achievements and areas for improvement that are yet to come as a result of what we can learn from these articles.
