Very preterm birth is associated with disabilities in multiple developmental domains.

OBJECTIVE: Follow-up studies in very preterm children usually present outcome for separate developmental domains. Presence of disabilities in more than one developmental domain will show a more serious outcome picture for extreme preterm infants and may be related to a different degree of perinatal problems. METHODS: At 5.5 years corrected age, outcome in the neurological, motor, cognitive, and behavioral domain was studied in 157 children born < 30 weeks gestation. The children were divided into a normal, a single, or a multiple disability group. Group differences in background, clinical characteristics, and neurodevelopmental outcome at 2 years were evaluated. RESULTS: Thirty-nine percent had a normal developmental outcome, 17% had a single disability, and 44% had multiple disabilities. Multiple disabilities were associated with lower birth weight, BPD, and difficulties according to neurodevelopmental assessments at 2 years. CONCLUSION: Assessments of different developmental domains show that most very preterm children had multiple disabilities.

Free thyroxine levels during the first weeks of life and neurodevelopmental outcome until the age of 5 years in very preterm infants.

BACKGROUND: We have conducted a randomized trial with thyroxine (T4) in 200 infants <30 weeks' gestation. T4 treatment was associated with better 5-year outcome in infants <29 weeks' gestation, but with worse outcome in infants of 29 weeks. These effects could be related to low, respectively high free thyroxine (FT4) levels METHODS: For each infant, the average FT4 of 5 scheduled measurements was calculated between day 3 and day 28. Infants of the placebo and the T4 group separately were divided in 2 groups. The placebo group consisted of a group of infants with average FT4 in the lowest quartile and a group in the upper 75%. The T4 group consisted of a group of infants with average FT4 in the upper quartile and a group in the lower 75%. Developmental outcome (mental/cognitive, motor, and neurologic) at 2 and 5.7 years was compared between high and low FT4 groups, and then compared separately for the T4 and placebo group. RESULTS: In the placebo group, low FT4 was associated with worse outcome on all domains at both time points. After correction for confounding variables, mental and neurologic outcome remained significantly different at 2 years, and motor outcome at 5 years. In the T4 group, high FT4 was not associated with worse outcome, neither at 2 nor at 5 years. CONCLUSIONS: In untreated infants, low FT4 values during the first 4 weeks after birth in infants born at <30 weeks' gestation are associated with worse neurodevelopmental outcome at 2 and 5 years. In T4-treated infants, high FT4 is not associated with worse outcome. Other factors than high FT4 concentrations must play a role in the worse outcome of the T4-treated group of 29 weeks' gestational age.

Neurodevelopmental outcome of children treated with antenatal thyrotropin-releasing hormone.

OBJECTIVE: To evaluate neurodevelopmental outcome until 2 years of age in children who participated in a multicenter antenatal thyrotropin-releasing hormone (TRH) trial to improve respiratory outcome and to lower mortality. METHODS: Neurodevelopmental outcome was studied in infants whose mothers were admitted to the Academic Medical Center and enrolled in the European Antenatal TRH trial. Mothers were treated for imminent preterm delivery (before 30 weeks) with corticosteroids plus either placebo (placebo-group) or TRH (TRH-group). TRH treatment consisted of 400 micro g every 8 hours up to 4 doses. Assessments included neurologic development at 12 months and psychomotor development at 12 and 24 months using the Bayley developmental scales. RESULTS: Sixty-two infants were included, 10 of whom died. Of the surviving infants, 24 received TRH and 28 received placebo. Ten infants were lost to follow-up. Each group consisted of 21 infants. Both groups were comparable regarding gestational age, birth weight, and time interval between trial medication and birth. However, in the TRH group, more respiratory problems, ventilator days, and chronic lung disease were found. Neurologic and motor outcome did not differ between the groups, but lower mental developmental index scores were found in the TRH group at both ages. CONCLUSIONS: Antenatal TRH treatment is associated with a delay in mental development. This study demonstrates the importance of long-term follow-up of perinatal intervention trials with possible consequences for neurodevelopmental outcome of the infant.