Neurodevelopmental Outcomes Up to 5 Years of Age in Very Preterm Infants: A Retrospective Cohort Study

Abstract

Introduction: The advances in neonatal care have led to a substantial increase in the survival rate of premature infants and, consequently, to a progressive attention to morbidity and neurodevelopmental outcomes in this population. The aim of this study was to evaluate very preterm children’s neurodevelopmental outcomes at 2 and 5 years of age, to examine the stability of developmental performance, and to identify neurodevelopment determinants at age 5.Methods: This retrospective cohort study included 85 very preterm infants (gestational age < 30 weeks or very low birth weight) born and followed at a Portuguese tertiary neonatal center. Neurodevelopment was assessed at ages 2 and 5 using the Griffiths Mental Development Scales (GMDS). Neurodevelopmental impairment (NDI) was classified as the combined outcome of GQ < 70, cerebral palsy, severe visual impairment or severe hearing impairment. The stability of GMDS quotients was assessed using Pearson correlation coefficients. Results: At age 2, 18.5% of children had developmental delay (GQ < 85) and 11.1% met criteria for NDI. By age 5, both rates decreased to 9.1%. Developmental quotients demonstrated strong longitudinal stability (r 0.67 - 0.92, all p < 0.001). While locomotor scores improved, ophthalmological abnormalities and the need for speech therapy were more frequent at preschool age. School assistance was required in 23.6%, and 48% needed at least one form of therapy by age 5. Griffiths Mental Development Scales scores at age 2, duration of oxygen therapy, and length of hospital stay were identified as predictors of neurodevelopment at age 5. Severe intraventricular hemorrhage (aOR = 18.0; CI 95%: 1.7 - 190.6) and prolonged hospitalization (aOR = 1.06; CI 95%: 1.01 - 1.11) were independent predictors of NDI.Conclusions: Early developmental assessment provides valuable prognostic information in very preterm children. Nevertheless, follow-up assessments beyond age 2 remain important for accurately identifying developmental needs.