Review ArticlePrediction of Neurodevelopmental Outcome After Preterm Birth
Introduction
Neurodevelopmental outcome after preterm birth varies widely and relates to time of onset, severity, and duration of injury, which result in different injury patterns [1]. Prediction of outcome remains difficult, particularly in the early postnatal period. The ability to better predict outcome in the infant period could substantially improve parental counseling and would also have the benefit of providing a better selection of infants for early therapeutic strategies. In addition, the efficacy of medical interventions and their potential negative effects on the central nervous system need to be identified. The spectrum and severity of deficits are underestimated when outcome is limited to early childhood examination.
Infants at highest risk for neurodevelopmental impairments are those born before 32 weeks of gestation. Infants who are born with a gestational age between 32 and 37 weeks have only a mildly increased risk for neurodevelopmental problems, unless there is cerebral injury, but they probably constitute a somewhat overlooked population.
Section snippets
Focus: Very Preterm Infants
Prematurity is usually defined by birth weight rather than by gestational age, due to uncertainty of obstetric estimation of gestational age and the lack of precision in postnatal gestational age assessment, particularly in very small infants [2]. Using birth weight as the defining factor for prematurity is problematic, however, because gestational age is the stronger determinant of biologic maturation and viability. Thus, outcome of premature infants born small for gestational age may be
Outcome
In principle, outcome can be categorized into severe and moderate-to-mild deficits. Severe deficits are summarized as functional disability, usually defined as an aggregate group comprising cerebral palsy, mental retardation (developmental or intellectual quotient of less than 70), and severe visual or hearing impairment [12]. Severe deficits can be detected by the age of 2 years. Moderate to mild deficits, however, are often not detected until school-age.
Prevalence rates differ considerably
Goal
Prediction of outcome is important, because knowledge of the spectrum and severity of neurodevelopmental sequelae is vital for decisions on withdrawal of support for neonates at the border of viability.
Prediction has been the focus of research for many decades. Biochemical markers such as pH, Apgar score, and base excess have been shown to be of little or no use for outcome prediction in term infants [48]. In preterm infants, these parameters play a secondary role. Thus, the focus has shifted
Perinatal Variables
A variety of prenatal and neonatal risk factors have been associated with adverse outcome for the preterm population. Gestational age or maturity at birth, along with birth weight, constitutes the strongest predictor of adverse neuromotor [22], [75], [76] and intellectual outcome [25], [77]. Other perinatal factors have also been related to adverse outcome, however, with a weaker association than maturity. Among those are preeclampsia [78], chorioamnionitis [22], [79], [80], sepsis [22], [70],
Conclusion and Future Directions
Children born prematurely are at risk for major and minor neurodevelopmental disabilities affecting long-term academic, behavioral, and social functioning. Prediction of outcome is of significance in the neonatal period, when new therapeutic interventions are introduced and decisions about withdrawal of support are made. Knowledge of the severity and spectrum of impairments is necessary for counseling parents, tailoring follow-up services, and allocating early intervention programs.
A detailed
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2020, NeuroImageCitation Excerpt :Together with the findings of the current study, this may suggest a specific misalignment between structure and function in conditions of impaired thalamocortical connectivity such as preterm birth, ASD or schizophrenia. Neurodevelopmental deficits including lower general cognitive abilities, executive dysfunctioning and poor academic abilities are frequent in very preterm children and adolescents even in the absence of major neurodevelopmental impairments (Aarnoudse et al., 2009; Brydges et al., 2018; Latal, 2009; Twilhaar et al., 2018). Importantly, intact thalamocortical connectivity has previously been shown to be essential for efficient cognitive functioning: For example, functional connectivity, particularly within the thalamus-salience network, predicted cognitive abilities at one year of age in healthy infants who underwent fMRI as neonates (Alcauter et al., 2014).
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2020, Pediatrics and NeonatologyCitation Excerpt :Cognition is a complex range of processes, broader than the general ability usually measured by developmental or intelligence quotients. This quotient is not a criterion in assessing the cognitive consequences of perinatal lesion in preterm infants, especially due to the fact that there is a substantial number of children with mild cognitive impairment.12,13 In addition to evidence of global intellectual delay in children with more severe lesions, children with perinatal injury may have specific deficits in numerous areas: visuo-motor integration, visuo-spatial processing, verbal and language functions, learning, memory, executive functions and attention.13–16