Risk Factors Of Neurodevelopmental Outcomes In Very/Extremely Low Birth Weight Infants

ObjectivesTo analyze the risk factors of adverse neurodevelopmental prognostic in very /extremely low birth weight infants(VLBW/ELBWI)and provide early warning indicators for early clinical intervention.MethodsThe VLBW/ELBWI admitted to the neonatal intensive care unit II of the First Affiliated Hospital of Zhengzhou University within 24 hours after birth between January 2016 and October 2016 were enrolled.These infants were followed up and neurodevelopmental evaluation was performed at a corrected age(CA)of 12 months by using the Bayley Scales of Infant Development II(BSID-II).According to the neurodevelopmental outcomes,they were divided into normal and abnormal neurodevelopment groups.The data of prenatal,intrapartum and postpartum in the two groups were compared.Potential risk factors of neurodevelopmental impairment were analyzed with Logistic stepwise regression.Results1.Follow-up situationA total of 167 VLBW/ELBWI were enrolled.14 cases died during hospitalization or after giving up treatment.At the CA of 12 months,13(8.5%)were lost to follow-up and 140(91.5%)infants completed follow-up.2.Short-term neurodevelopmental prognosis of VLBWI/ELBWIA total of 140 VLBWI/ELBWI were enrolled,28 cases with extremely low birth weight,112 cases with very low birth weight,male 86 cases,female 54 cases,gestational age(30.4±2.2)weeks(25.3～36.0 weeks).Follow up to 12 months of correction age,15 cases(10.7%)suffered from neurodevelopmental impairment(NDI),of which 3 cases(2.2%)with single mental developmental index(MDI)<70 score in Bayley II,8 cases(5.7%)with simple psychomotor developmental index(PDI)< 70 score,and 4 cases(3%)with MDI < 70 score and PDI < 70 score.Hearing damage requiring hearing aid and blind in eyes were not found in any of the children.3.Common complications of VLBWI/ELBWIAmong 140 VLBWI/ELBWI,127 cases were diagnosed with neonatal respiratory distress syndrome(RDS),9 cases were diagnosed with sepsis,5 cases with pulmonary hemorrhage,36 cases with retinopathy of prematurity(ROP),42 cases with bronchopulmonary dysplasia(BPD),48 cases with patent ductus arteriosus(PDA),45 cases with neonatal thrombocytopenia,14 cases with severe asphyxia,77 cases with III or IV grade intracranial hemorrhage.4.The univariate analysis of short-term neurodevelopmental prognosis in VLBWI/ELBWIThe results of univariate analysis showed that birth weight<1000g,exposure to antenatal steroids,N-terminal brain natriuretic peptide(NT-proBNP)≥35000ng/l and the incidence of Bronchopulmonary dysplasia(BPD)in the two groups were statistically significant(P < 0.05).5.Logistic regression analysis of neurodevelopmental prognosis in VLBWI/ELBWILogistic stepwise regression showed that NT-proBNP level ≥35000ng/l may independently predict neurodevelopmental impairment among VLBWI / ELBWI(OR=22.774,95%CI: 3.079~168.425,P=0.002).Exposure to antenatal steroids may be a protective factor for neurodevelopmental impairment(OR=0.125,95%CI: 0.020～0.782,P=0.026).6.The relationship between the level of NT-proBNP during neonatal period and the prognosis of neurodevelopment in VLBWI/ELBWIThe subjects were divided into two groups with(n=23)and without(n=92)NT-proBNP level ≥ 35000ng/l,neurodevelopmental outcomes between the two groups were compared,the results showed that MDI scores and PDI scores of the group with NT-proBNP level ≥ 35000ng/l were significantly lower than the group without NT-proBNP level ≥ 35000ng/l(P < 0.05).7.The relationship between prenatal application of dexamethasone and the prognosis of neurodevelopment in VLBWI/ELBWIThe subjects were divided into two groups that were respectively exposed to antenatal steroids(n=108)and were not exposed to antenatal steroids(n=32),neurodevelopmental outcomes between the two groups were compared,the results showed that PDI scores of the group exposed to antenatal steroids were slightly higher than the control group,but the difference was not statistically significant(P﹥0.05).Conclusion1.Heart failure may be an independent risk factor for poor poor neurodevelopmental prognosis in VLBWI/ELBWI.2.Antenatal corticosteroids may be the protective factor of poor neurodevelopmental outcomes.Obstetricians should be aimed at the application of steroid hormones in pregnant women with high risk of premature birth,in order to reduce the mortality of preterm infants,as far as possible to improve the long-term neurodevelopmental prognosis of high-risk infants.