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Chapter 58: Long-Term Neurodevelopmental Impairment

Shannon N. Liang; Cynthia E. Rogers; Christopher D. Smyser

SCOPE

DISEASE/CONDITION(S)

Neurodevelopmental impairment in infants born preterm.

GUIDELINE OBJECTIVE(S)

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.

BRIEF BACKGROUND

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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TABLE 58.1. Neurodevelopmental Impairment in Very Preterm Children
Type of Neurodevelopmental or Functional Impairment Patient Category and Prevalence
Cognitive impairment or intellectual disability

Severe in 10% of VPT infants

Mild to moderate in 30–50% of VPT infants >50% of VLBW young adults have an IQ >1 SD below the mean
Cerebral palsy

Severe in 5–15% of VPT infants*

Mild to moderate in 30–50% of VPT infants
Visual impairment

Unilateral or bilateral blindness in 1–10% of extremely-low-birthweight infants

Mild to moderate in 30–50% of VPT infants
Hearing impairment Up to 14% in VPT infants (10% require amplification)
Language impairment 20–35% in VPT infants
Impaired school performance

More likely to leave school at an earlier age

Less likely to graduate from high school†

Less likely to attend college and graduate from 4-year universities
Behavioral and psychiatric problems

Behavioral problems in 25–28% of VPT children

Higher rates of subclinical psychiatric symptoms‡

Autism spectrum disorder in 8% of extremely preterm infants

ADHD§ in 15–27% of VLBW children

Increased risk-taking behaviors (e.g., smoking, drinking alcohol, and drug use)

Less likely to establish an independent adult life

*The most common form of cerebral palsy is spastic diplegia (40–50%), ...

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