article · Archives of Disease in Childhood Fetal & Neonatal
A study of over 6,600 extremely preterm infants born before 28 weeks of gestation between 2010 and 2019 in Australia and New Zealand evaluated neurodevelopmental impairment at two to three years of age. Overall, 15.5 percent of surviving infants experienced neurodevelopmental impairment, with developmental delay being the most frequent issue, particularly affecting language, motor, and cognitive domains. Coexisting neonatal morbidities significantly increased impairment odds, more than tripling for infants with three or more conditions. When comparing outcomes from 2010 to 2014 against 2015 to 2019, rates of bronchopulmonary dysplasia, retinopathy of prematurity, and developmental delay grew. This shift resulted in a 6.6 percent absolute increase in overall impairment between the two periods. The highest impairment rates appeared in infants born at 22 to 23 weeks, highlighting a pressing requirement to reduce neonatal morbidities and improve neuroprotective care.
As medical advances allow more extremely preterm infants to survive, tracking their long-term health is vital for families, healthcare systems, and social services. Demonstrating that developmental delays and impairment rates have risen alongside specific neonatal morbidities helps healthcare providers anticipate long-term support requirements and focus clinical attention on improving neuroprotective practices during early neonatal care.
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OBJECTIVE: To evaluate neurodevelopmental outcomes at 2-3 years of age among survivors of extremely preterm infant (EPI). DESIGN AND SETTING: Analysis of prospectively collected Australian and New Zealand Neonatal Network data on infants born <28 weeks' gestation between 2010 and 2019. MAIN OUTCOME: The prevalence of neurodevelopmental impairment (NDI), defined as any moderate to severe cerebral palsy (CP), sensory impairment or developmental delay (score <70) at 2-3 years of age was determined. Epoch comparisons (2010-204 vs 2015-2019) and the impact of major morbidity on NDI were examined, adjusting for maternal age, antenatal steroids, gestational age, Apgar score, admission temperature, sex and breast milk feeding. RESULTS: Of 6617 EPIs, 15.5% had NDI. Developmental delay was most prevalent (14.5%), including language (11.1%), motor (5.9%), cognitive (5.7%) domains, followed by CP (3.2%), deafness (1.4%) and blindness (0.4%). Compared with infants without morbidity, adjusted odds of NDI increased with one (adjusted OR (aOR) 1.50, 95% CI 1.21 to 1.84), two (aOR 2.09, 95% CI 1.60 to 2.53) and three or more coexisting morbidities (aOR 3.56, 95% CI 2.73 to 4.65). Between epochs, bronchopulmonary dysplasia increased by 6.9% and retinopathy of prematurity by 3.8%, alongside a rise in developmental delay (10.3% to 17.8%), contributing to a 6.6% absolute increase in NDI. Survivors born at 22-23 weeks had the highest NDI rates, increasing from 23.0% to 26.4%. CONCLUSION: NDI rates among EPI increased over time and were associated with increasing multiple morbidities. Although changes in EPIs survival patterns may have contributed to these trends, reducing neonatal morbidities and strengthening neuroprotective care remain priorities.
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DOI: 10.1136/archdischild-2025-330101
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