Riassunto analitico
Despite the increased survival rate of preterm newborns worldwide, due to modern neonatal intensive care methods, the risk of neurodevelopmental disabilities remains high. It is a widely recognized fact that preterm birth is not an acute issue, but rather a chronic condition that can manifest over time. As clinicians, our responsibility to these patients does not end at the time of discharge, but rather, it must persist over time. Follow-up care is a fundamental tool, and its primary objectives are to promptly identify children with disabilities and to evaluate the quality of medical care provided to them.
The present longitudinal study aims to describe neurodevelopmental outcome at 24 months of corrected age in a cohort of VLBW infants admitted to a single Italian tertiary NICU, and to look for correlations between perinatal variables and cerebral MRI at TEA and short-term neurodevelopmental outcome.
Infants underwent cerebral MRI examinations at term of gestation as part of a detailed neurological evaluation conducted in our unit. Moreover at 24 months, Griffiths’ Mental Developmental Scales were administered.
Neurodevelopmental outcome was classified as: normal, minor sequelae (minor neurological signs, General Quotient between 76 and 87), major sequelae (Cerebral Palsy; General Quotient ≤ 75; severe sensory impairment). Among 222 infants that applied to follow-up, 77.9% (n=173/222) showed a normal outcome, 15.3% (n=34/222) minor sequelae and 6.8% (n=15/222) major sequelae. In the “major sequelae” group, 8 infants (3.6% of the whole sample) had CP. Retinopathy of prematurity (ROP) and periventricular-intraventricular hemorrhage (PIH) were independently associated with poor outcome on multivariate ordered logistic regression. These findings suggest that the severity of outcomes observed in the sample is slightly less severe than previously reported in the existing literature.
Among the infants who underwent MRI, 78 out of 221 (35%) had normal MRI, while 143 out of 221 (64.7%) had one or more types of abnormalities. Furthermore, 70 out of 221 (31.7%) infants had lesions in more than one category. We found that normal cerebral MRI is significantly correlated with a normal outcome. Conversely, the presence of any cerebral MRI abnormality is associated with variable outcome. Hemorrhagic Parenchymal Infarction (HPI) and periventricular leukomalacia (PVL) are significantly correlated with a severe outcome. However, other lesions such as ventriculomegaly, abnormal myelin, and germinal matrix hemorrhage (GMH) have variable outcome, possibly because the lesion degree may have a role in determining the presence and severity of sequelae.
In the lower gestational age categories, we found a distinct disharmonic neurodevelopmental profile with language impairment. Our study supports further follow-up programs with the aim to form a national network perspective. Such networks will contribute to promoting access to formal neurodevelopmental evaluation and to timely rehabilitative interventions.
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