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Preterm Neurodevelopmental Trajectories from 18 Months to 4.5 Years - 05/07/23

Doi : 10.1016/j.jpeds.2023.113401 
Rhandi Christensen, MD, PhD, FRCPC 1, Vann Chau, MD, FRCPC 1, Anne Synnes, MHSc, MDCM, FRCPC 2, Ting Guo, PhD 1, Ruth E. Grunau, PhD 2, , Steven P. Miller, MDCM, MAS, FRCPC 2,
1 Division of Neurology, Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada 
2 Department of Pediatrics, University of British Columbia and BC Children’s Hospital, Vancouver, British Columbia, Canada 

Reprint requests: Steven P. Miller, MDCM, MAS, FRCPC, Department of Pediatrics, BC Children’s Hospital, 2D15—4480 Oak St, Vancouver, British Columbia, V6H 3V4, Canada.Department of PediatricsBC Children’s Hospital2D15—4480 Oak StVancouverBritish ColumbiaV6H 3V4Canada

Abstract

Objective

To assess the longitudinal trajectory of cognitive, language, and motor outcomes from 18 months to 4.5 years of age in children born very preterm.

Study design

This was a prospective cohort study of 163 infants born very preterm (born 24-32 weeks of gestation) followed longitudinally and assessed with neurodevelopmental scales and magnetic resonance imaging of the brain. Outcomes at 18 months and 3 years were assessed with the Bayley Scales of Infant and Toddler Development, 3rd Edition, and at 4.5 years with the Wechsler Preschool and Primary Scale of Intelligence-III and the Movement Assessment Battery for Children. Cognitive, language, and motor outcomes were categorized as below-average, average, and above-average, and compared across time. Clinical data were analyzed using ANOVA, χ2 tests, and linear regression.

Results

Cognitive and language trajectories were stable from 18 months to 4.5 years for all outcome groups. Motor impairment increased over time, with a greater proportion of children having motor deficits at 4.5 years. Children with below-average cognitive and language outcomes at 4.5 years had more clinical risk factors, greater white matter injury, and lower maternal education. Children with severe motor impairment at 4.5 years were born earlier, had more clinical risk factors, and demonstrated greater white matter injury.

Conclusions

Children born preterm have stable cognitive and language trajectories, while motor impairment increased at 4.5 years. These results highlight the importance of continued developmental surveillance for children born preterm into preschool age.

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Abbreviations : BPD, Bayley-III, MABC, MRI, ROP, WPPSI-III


Mappa


 This study was funded by the Canadian Institutes of Health Research operating grants MOP-79262 (to S.M.), MOP-86489 (to R.G.), and Kids Brain Health Network. S.M. was supported by the Bloorview Children’s Hospital Chair in Paediatric Neuroscience (to 2022) and is currently supported by the James & Annabel McCreary Chair in Pediatrics (UBC). R.G. is supported by an investigator salary award from the BC Children’s Hospital Research Institute. The authors declare no conflicts of interest.


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