Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
The incidence of motor, cognitive, and language delay among children who were born preterm (< 32 weeks gestation) is high. Estimated gestational age at birth appears to influence the timing of discharge, with infants born earlier being discharged later after accounting for the degree of prematurity. Postmenstrual age at discharge appears to be related to motor outcome in early childhood, shedding light on the high-risk nature of this population of infants still hospitalized after their due date.
Primary Author and Speaker: Polly Kellner
Additional Authors and Speakers: Jenny Kwon
Contributing Authors: Roberta Pineda
PURPOSE: 1) Define prevalence of motor, cognitive and language delays in children who were born < 32 weeks estimated gestational age (EGA), 2) define timing of discharge from the neonatal intensive care unit (NICU) as it relates to EGA, 3) define timing of discharge from the NICU to neurodevelopmental outcome in early childhood.
DESIGN: A retrospective study defining medical factors and timing of discharge in the NICU and following infants until they received standardized neurodevelopmental assessment in early childhood.
METHOD: A retrospective study consisting of 316 preterm infants born < 32 weeks EGA and hospitalized in a level IV NICU who returned to Newborn Follow Up clinic for standardized neurodevelopmental assessment. Medical information and timing of discharge were extracted from the electronic medical record and included the length of stay (in days) and the postmenstrual age (PMA) at discharge. All infants born < 32 weeks EGA are scheduled for routine follow up assessments at the study site. Of infants who returned for follow-up visits, those who completed standardized Bayley Scales of Infant Toddler Developmental 3rd Edition were included in analysis. Timing of assessment ranged from 11 months to 21 months. The incidence of developmental impairment across the sample was determined using descriptive statistic. Linear regression models were used to evaluate the EGA at birth in relation to the PMA at discharge. Additionally, linear regression models were conducted to investigate relationship of PMA at discharge to language, cognitive, and motor outcomes in childhood using the Bayley Scales of Infant Toddler Developmental 3rd Edition
RESULTS: 26 (14.4%) infants were discharged prior to or at 36 weeks PMA, 94 (51.9%) were discharged between 37-40 weeks PMA, and 61 (33.7%) were discharged after 40 weeks PMA. Infants were discharged from 27 weeks to 58 weeks post term. Using a cut-off of 85 on the Bayley Scales of Infant Toddler Developmental 3rd Edition, 19 (18.8%) had motor delay, 46 (45.5%) had language delay, and 26 (25.7%) had motor delay. The mean scores of the cognition, language, and motor development were 94.01 ± 15.27, 84.89 ± 18.13, and 91.17 ± 18.60, respectively. Additionally, the EGA was significantly associated with PMA (p = 0.017; β = -0.017), and the PMA at time of discharge was related to motor outcome (p = 0.002; β = -0.534). PMA at time of discharge was not related to language or cognitive outcome.
CONCLUSION: The incidence of motor, cognitive, and language delay in children who were born preterm was high. EGA appears to influence the timing of discharge, with infants born earlier being discharged later after accounting for the degree of prematurity. PMA at discharge also appears to be related to motor outcome in early childhood. This knowledge sheds light on the high-risk nature of this population of infants still hospitalized after their due date and can better inform discharge planning and need for early intervention.
References
Stephens, B. E., & Vohr, B. R. (2009). Neurodevelopmental outcome of the premature infant. Pediatric clinics of North America, 56(3). https://doi.org/10.1016/j.pcl.2009.03.005
Adams-Chapman, I., & DeMauro, S. B. (2018). Neurodevelopmental Outcomes of the Preterm Infant. Clinics in perinatology, 45(3), xvii–xviii. https://doi.org/10.1016/j.clp.2018.06.001
Kuo, D. Z., Lyle, R. E., Casey, P. H., & Stille, C. J. (2017). Care System Redesign for Preterm Children After Discharge From the NICU. Pediatrics, 139(4), e20162969. https://doi.org/10.1542/peds.2016-2969
