Extreme Preemies With Neurodevelopmental Impairment at Age 2 May Improve by Age 10

By Linda Carroll

April 07, 2021

(Reuters Health) - More than one quarter of babies who were born extremely premature and display neurodevelopmental impairments at age 2 may improve significantly by age 10, according to a new study.

An analysis of data from 802 children who were born extremely premature, revealed that 63% of 227 classified as having moderate to severe neurodevelopmental impairment (NDI) at age 2, had none to mild NDI at age 10. Among 108 children classified as having profound NDI at 2 years, 36% had none to mild NDI at 10 years, researchers report in Pediatrics.

Overall, 67% of the children had no change in NDI classification between 2 and 10 years of age, 27% improved and 5% worsened, the authors note.

"I hope these findings will allow parents and medical professionals to leave room for optimism when they hear a baby has been born extremely premature with profound neurodevelopmental impairments," said Dr. Genevieve Taylor, an assistant professor in the division of neonatal and perinatal medicine at the University of North Carolina, Chapel Hill. "It's definitely a complex issue and there are limitations to our study, but it's exciting that in this cohort we found even in those kids classified as having severe neurodevelopmental impairment at age 2, many went on to have improved classifications at 10."

The study underscores how plastic kids' brains are at age 2, Dr. Taylor said. "It demonstrates that kids at age 2 are still developing and that kids are resilient," she added. "It also shows that there are some limitations of assessing neurodevelopmental impairment at age 2."

To take a closer look at how very premature children who start out with severe NDI develop over time, Dr. Taylor and her colleagues turned to data from the Extremely Low Gestational Age Newborn (ELGAN) Study, a cohort of children born extremely premature at multiple sites in the U.S. who had neurodevelopmental assessments at 2 and 10 years of age. The researchers hypothesized that NDI at age 2 would have limited predictive accuracy for NDI at age 10.

Out of 1,506 infants, 80% survived. Data were sufficient for analysis in 67% of those children (802), of whom 5% were born at 23 weeks' gestation, 15% at 24 weeks, 20% at 25 weeks, 25% at 26 weeks, and 35% at 27 weeks.

When the children were 2, trained examiners administered the Bayley Scales of Infant Development Second Edition (BSID-II), performed a standardized neurologic examination, and assigned Gross Motor Function Classification System (GMFCS) scores.

For children with an impairment that precluded BSID-II testing as well as those for whom more than two test items were omitted, the Vineland Adaptive Behavior Scales Motor Skills Domain was used instead of the BSID-II. At age 10, IQ was assessed with the Differential Ability Scales, Second Edition (DAS-II).

The proportion of children classified as having profound NDI decreased from 13% at age 2 to 6% at age 10. The proportion classified as having moderate to severe NDI decreased from 28% to 17%. The proportion classified as having none to mild NDI increased from 58% to 77%.

"Having a preemie is very scary," said Kimberly Blair, an associate professor of psychiatry at the University of Pittsburg and senior academic director of the UPMC Matilda Theiss Early Childhood Behavioral Health Program.

The study shows there is room to have optimism about the outcomes for these children, said Blair who was not involved in the new research. "The brain is an amazing organ with so much capacity to change and to make lots of gains," she added. If kids start off with disadvantages, like being premature, so much goes into growth - nutrition, stimulation, environment. Getting early supports and services is really important."

Traditionally, research on NDI is based on 2-year-old outcomes, said Dr. Joanna Burton, a neurodevelopmental neurologist at the Kennedy Krieger Institute in Baltimore. "This shows we need more long-term outcomes research," said Dr. Burton who was not involved in the new study. "Also, when we're talking to families, it's important to say that what we see at age 2 doesn't always predict how children will be when they are older."

It's important to remember that even children with more severe outcomes, such as cerebral palsy and intellectual disability, it doesn't mean they can't shift to better ones, said Gwyn Gerner, a neuropsychologist at Kennedy Krieger. "If we are able to supply support, they may fall into a more moderate range," Gerner said. "Some think that when there's a severe outcome there is not much we can do. There's actually a lot we can do."

SOURCE: https://bit.ly/31SaGY4 Pediatrics, online April 6, 2021.