Presented at the Neonatal Society 2018 Autumn Meeting.
Durrant C1, Wong H2, Cole TJ1, Hutchon B3,4, Collier L3,4, Wright A3,4, George C3,4, de Haan M1, Huertas A3,4
1 University College London, UK
2 University of Cambridge, UK
3 University College London Hospital, UK
4 North Central London Perinatal Network, UK
Background: Different patterns of neurodevelopmental trajectories may represent different underlying brain maturation or disease processes. Most neonatal studies report neurodevelopmental outcomes of children born preterm at single time points. The variation in developmental trajectories of children born preterm is unknown. We aimed to describe the cognitive, communication, and motor developmental trajectories in children born very preterm (<30 weeks gestation) and identify neonatal factors that predict negative developmental trajectories. We hypothesized that lower gestational age, lower birth weight, male sex and multiplicity are independent risk factors for adverse developmental trajectories.
Methods: A retrospective cohort of 1,142 very preterm infants born between 1st January 2005 and 31st December 2015 in the North Central London Perinatal Network who received routine developmental assessment using the Bayley Scales of Infant Development, 3rd edition (Bayley-III) around 3, 6, 12 and/or 24 months corrected (post-term) age were included. Neonatal data and Bayley-III scores of the participants were extracted from their medical records. Developmental trajectory curves of cognitive, communication and motor skills were constructed using SuperImposition by Translation and Rotation (SITAR) modelling. The effect of gestational age, birth weight, sex and multiplicity on developmental trajectories were assessed using multiple regression analysis.
Results: There were wide variations in developmental trajectories in all scales (figure). There was too much variation in the expressive communication scale to fit a SITAR model, therefore it was not included in the multiple regression analysis. Lower gestational age, lower birth weight and male sex significantly predicted a slower rate of development for all four scales. Being a twin was significant for the cognition and motor scales.
Conclusion: The rate of development, rather than an infant’s starting point, was the best explanation for the variation in trajectories and should be the focus for monitoring and early intervention. A number of neonatal factors significantly predicted rate of development.
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Cole, T. J., Donaldson, M. D. & Ben-Shlomo, Y. (2010). SITAR – a useful instrument for growth curve analysis. International Journal of Epidemiology, 39, 1558-1566.