Pediatric Pearls: Predicting Long-Term Neurological Impairment

The Research

In this study, developmental outcome of children aged 10 years was compared with assessment of children aged 2 years for 802 surviving children of an initial cohort of 1506 infants born at fewer than 28 weeks' gestation at 14 hospitals across 5 states. 

The Results

Overall, 67% of children showed no change in level of neurodevelopmental assessment, 27% showed improvement, and 5% showed worsening. Of note, 63% of the children with moderate to severe neurodevelopmental impairment at 2 years of age and 36% of the children with profound neurodevelopmental impairment at 2 years of age had mild or no impairment at 10 years of age.

What's the Take Home?

The optimistic perspective reflected by the authors is helpful in the way that I counsel parents or guardians of these children in my practice. Far from a static encephalopathy, the data presented here strongly support the plasticity of the central nervous system in these children and their ability to improve neurodevelopmental outcomes even in the most profoundly affected neonates born extremely premature. This study will support my approach of encouraging early and aggressive developmental intervention and offering hope to parents or guardians, including among the earliest and most severely affected preterm neonates.

Reference

1. Taylor GL, Joseph RM, Kuban KC, et al. Changes in neurodevelopmental outcomes from age 2 to 10 years for children born extremely preterm. Pediatrics. 2021:147(5):e2020001040. https://doi.org/10.1542/peds.2020-001040

Scott T. Vergano, MD is a pediatrician in the Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA