Neurodevelopmental outcomes of the late preterm infant
Introduction
In 2005, the National Institute of Child Health and Human Development renamed the group of infants with gestational ages 340/7–366/7 weeks from “near term” to “late preterm” [1]. They felt that this designation would be helpful to convey the fact that these infants, although “close to term,” have higher rates of morbidity and mortality than full term infants. Previously, physicians underestimated their risk for morbidity and mortality which led to less thorough evaluation, monitoring, and follow-up. At the same time these infants were re-labeled “late preterm,” there was also a call for research into their short and long term outcomes.
Since 2005, more research has been done into the short and long term outcomes of late preterm infants (LPI) which confirmed that they act more like preterm infants with metabolic, neurologic, and physiologic immaturities, and are at higher risk for mortality as well as multiple morbidities. Research has also verified that preterm infants, including LPI, are at higher risk for having neurodevelopmental delays and problems than full term infants (FTI). Outcome studies of LPI indicate that they are at increased risk of developmental disability, school failure, behavior problems, social and medical disabilities, and death.
Although more research has been done, we have yet to settle several questions: Which LPI are at highest risk for neurodevelopmental struggles? Are there specific delays that are common in LPI or are they global? Do the observed delays demonstrate a lag in development that may resolve, or are they associated with life-long issues? Is there opportunity to proactively intervene leading to better outcomes?
Section snippets
Early developmental outcomes
Current published research on neurodevelopmental outcomes has examined infants and children across a broad range of ages. Some reports have focused on neurodevelopmental outcomes during the period between birth hospital discharge and school age (0–5 years). Often, they have compared results between LPI and FTI, including early developmental outcomes, rates of cerebral palsy and other neurologic diagnoses, speech and language issues, as well as rates of referral and usage of early intervention
School-age outcomes
It is important to look at school performance when discussing neurodevelopmental outcomes, as it is an indicator of future academic achievement, employment prospects, socio-economic status, and adult health. There are many reports of LPI neurodevelopment during this time-period using multiple different measures including standardized testing, need for special education, as well as specific outcomes such as language and social outcomes.
In a study looking at Florida state records from early
Adolescent age and adulthood
There are few papers that follow LPI into adolescence and adulthood. Such studies come out of Scandinavia where the countries have National Health Registries. We should be careful when generalizing these results, however, because many of the participants were born as many as 50 years ago. Since then, neonatal care has improved considerably. Accordingly, it remains uncertain whether the same results would be observed among the current late preterm population if followed into the future.
Moster
Conclusions
This review demonstrates that LPI have significantly worse performance across a range of cognitive and educational measures compared with FTI. Given the high prevalence of late preterm births, even small differences in abilities, special education, and length of education may have broader consequences. There are still many questions that remain unanswered. First, we do not know which subpopulation of these infants is at the highest risk. Is there a certain vulnerable subgroup, such as those who
Research directions
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Define the specific risks experienced by late preterm infants.
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Identify high-risk groups within the late preterm gestation.
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Studies should adopt uniform gestational age categories, use full term infants as controls, and use standardized and validated outcome measures.
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Analyses should be longitudinal to follow neurodevelopment over time and identify points for therapeutic intervention.
Conflicts of interest
None declared.
Funding sources
None.
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