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Neurodevelopmental impairment in infants born preterm.


To review the frequency and impact (medical, social, and economic) of and contributors to long-term neurodevelopmental impairment in preterm infants. To discuss methods to predict and improve neurodevelopmental outcomes in these infants. Outcomes in term infants are not addressed in this chapter.


Prevalence of Neurodevelopmental Impairment

The improved survival rates for preterm infants over the past several decades have not translated into improvements in long-term neurodevelopmental outcomes. Preterm birth remains a leading cause of neurological and neurodevelopmental disabilities worldwide. In the United States alone, the medical costs associated with preterm birth amount to $17 billion per year, with combined costs of medical and social services amounting to more than $26 billion.

Very Preterm Infants (Born <32 Weeks’ Gestation)

Infants born at the earliest gestational ages experience the greatest rates of adverse neurodevelopmental sequelae. Impairments include cognitive, language, motor, social, and behavioral disability, with 30–50% of very preterm (VPT) children experiencing impairments across multiple developmental domains. Approximately 10% of VPT infants experience severe deficits associated with functional disability, including cerebral palsy (CP), intellectual disability (IQ <70), and/or severe visual or hearing impairments. Many deficits are identifiable by 2 years of age. Mild to moderate deficits are seen in an additional 30–50% of VPT infants, with some impairments not evident until school age. Table 58.1 provides a summary of the literature regarding the prevalence of neurodevelopmental challenges for VPT infants.

TABLE 58.1.Neurodevelopmental Impairment in Very Preterm Children

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