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Research article
Neurodevelopmental outcome in extremely low birth weight infants in Johannesburg, South Africa
Tanusha Ramdin
University of the Witwatersrand Faculty of Health Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9490-6916
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Improved survival in preterm infants whether due to technological progress or treatment like antenatal steroids, surfactant administration or nasal continuous positive airway pressure (NCPAP) and aggressive resuscitation have raised the question about whether the survivors would be more prone to increased morbidity and adverse neurodevelopmental disability.
Methods: This was a prospective follow-up study conducted in the neonatal unit of a tertiary hospital in Johannesburg, South Africa. Bayley scales of infant and toddler development, version III, were conducted on a group of extreme low birth weight infants (ELBWI). The mean composite cognitive, language and motor sub-scales were reported. Infants were considered to be “at risk” if the composite subscale score was below 85 and “disabled” if the composite subscale score was below 70. Infants identified with cerebral palsy were also reported.
Results: The mean birth weight of the study group was 858.5grams (95% CI 839.2- 877.8) and the mean gestational age was 27.5 weeks (95% CI 27.1-27.9). The majority of ELBWI enrolled in the study had at least one Bayley at a mean corrected age of 17.09 months (CI 16.04 to 18.14). The mean composite scores for cognition were 98.4 (CI 95.1-101.7), language 90.0 (CI 87.5-92.6) and motor 97.9 (CI 94.8-101.0). All mean scores fell within the normal range, but the composite language score was the lowest. The study did not diagnose cerebral palsy in any of the infants. The study found 28 (36.3%) infants to be “at risk” for neurodevelopmental delay. Significantly more males were classified as “at risk” than females (13/25 (52%) vs. 15/52 (28.8%). Late onset sepsis (sepsis18/37 (48.6%) vs. no sepsis 10/40 (25%) p=0.031) and longer duration of ventilation (median of 12 days (IQR 46) vs. median of 4.0 days (IQR 5) p=0.048) were significantly associated with an “at risk” classification.
Conclusion: Rates of early neurodevelopmental impairment have altered minimally despite significant improvements in the overall survival of ELBWI. It is of paramount importance to ensure that early neurodevelopmental outcomes are accurately assessed so as to assist doctors and families in establishing a foundation for advocacy for the immediate intensive care and post discharge follow up.
Keywords
extreme low birth weight infants, neurodeveloment, middle income contries, intensive care
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This is a preprint. It has not completed peer review.
Research article
Neurodevelopmental outcome in extremely low birth weight infants in Johannesburg, South Africa
Tanusha Ramdin
University of the Witwatersrand Faculty of Health Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-9490-6916
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 31 May, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pediatrics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Improved survival in preterm infants whether due to technological progress or treatment like antenatal steroids, surfactant administration or nasal continuous positive airway pressure (NCPAP) and aggressive resuscitation have raised the question about whether the survivors would be more prone to increased morbidity and adverse neurodevelopmental disability.
Methods: This was a prospective follow-up study conducted in the neonatal unit of a tertiary hospital in Johannesburg, South Africa. Bayley scales of infant and toddler development, version III, were conducted on a group of extreme low birth weight infants (ELBWI). The mean composite cognitive, language and motor sub-scales were reported. Infants were considered to be “at risk” if the composite subscale score was below 85 and “disabled” if the composite subscale score was below 70. Infants identified with cerebral palsy were also reported.
Results: The mean birth weight of the study group was 858.5grams (95% CI 839.2- 877.8) and the mean gestational age was 27.5 weeks (95% CI 27.1-27.9). The majority of ELBWI enrolled in the study had at least one Bayley at a mean corrected age of 17.09 months (CI 16.04 to 18.14). The mean composite scores for cognition were 98.4 (CI 95.1-101.7), language 90.0 (CI 87.5-92.6) and motor 97.9 (CI 94.8-101.0). All mean scores fell within the normal range, but the composite language score was the lowest. The study did not diagnose cerebral palsy in any of the infants. The study found 28 (36.3%) infants to be “at risk” for neurodevelopmental delay. Significantly more males were classified as “at risk” than females (13/25 (52%) vs. 15/52 (28.8%). Late onset sepsis (sepsis18/37 (48.6%) vs. no sepsis 10/40 (25%) p=0.031) and longer duration of ventilation (median of 12 days (IQR 46) vs. median of 4.0 days (IQR 5) p=0.048) were significantly associated with an “at risk” classification.
Conclusion: Rates of early neurodevelopmental impairment have altered minimally despite significant improvements in the overall survival of ELBWI. It is of paramount importance to ensure that early neurodevelopmental outcomes are accurately assessed so as to assist doctors and families in establishing a foundation for advocacy for the immediate intensive care and post discharge follow up.
Figure 1