Very early preemies face serious neurodevelopmental risks

By Genevra Pittman

NEW YORK (Reuters Health) - Babies born at 25 weeksgestation or earlier have a "substantial likelihood" of having avery low IQ or other neurodevelopmental problems in childhood,researchers said today.

In a review of nine past studies, they found that 24% to 43%of extremely premature infants went on to have moderate orsevere impairment, depending on early they were born.

Dr. Henry Lee, from the Division of Neonatal & DevelopmentalMedicine at Stanford University and Lucile Packard Children'sHospital in California, said it's a "very difficult circumstancefor the family" when a baby is born between 22 and 25 weeks.

Twenty-two weeks is considered the earliest a baby can beborn and still have a chance of surviving. But the odds can beso low, and the risks so high, that some hospitals might noteven offer aggressive care to preemies delivered at 22 to 23weeks, said Dr. Lee, who wasn't involved in the new research.

"First of all, they're at high risk of not even surviving,even when everything is done to help them," he told ReutersHealth. "Even when they do survive, they have high rates ofdisability."

He said the new data could be used to help counsel familiesof extremely premature infants.

"It's hopefully an informed decision that the family makesin terms of how they're going to proceed, whether to try toprovide very aggressive, intensive care to these infants orpotentially to provide palliative and comfort care," he said.

"The hard part too is there is still uncertainty. Eventhough there is this risk, there are some infants at each ofthese gestational ages that will survive and not havedisability."

For the analysis, Dr. Gregory Moore from The Ottawa Hospitalin Ontario, Canada and colleagues pooled the results of ninestudies that assessed kids born between 22 and 25 weeks'gestation when they were four to eight years old. Most of thestudies were conducted in Europe and together they includedclose to 900 children.

Moderately or severely impaired children were those scoringin the lowest 2% to 3% on IQ tests, children with cerebralpalsy, and those who were fully or mostly deaf or blind.

Studies varied widely in the frequency of impairment theyreported, likely based in part on different practices indifferent regions, the researchers said.

They found that across the board, children were at risk ofneurodevelopmental problems - although those risks declined forevery extra week in utero.

Among babies born at 22 weeks, 43% were impaired, comparedto 40% of those born at 23 weeks, 28% born at 24 weeks and 24%born at 25 weeks' gestation, the study team reported Monday inJAMA Pediatrics.

About 4% to 5% of full-term babies go on to have some typeof developmental problem, Dr. Moore said, but that includeschildren with milder impairment as well.

"Although substantial numbers of extremely preterm infantsgo on to develop moderate to severe (neurodevelopmentalimpairment), the results are not completely bleak in that overhalf of the children studied did not go on to develop moderateto severe impairment," said Dr. Kimberly Noble, a pediatricianwho studies child brain development at Columbia University inNew York.

Dr. Noble, who wasn't involved in the new research, toldReuters Health by email that it's unclear whether rates ofimpairment would be similar for U.S. babies born very early.

Dr. Moore, also from The Children's Hospital of EasternOntario, said the findings were limited by the small number ofchildren born at the earliest gestations included in thestudies.

"We don't want these (data) to make a physicianautomatically say, 'There's no hope' or, 'There's no chance,'"he told Reuters Health.

But, he added, "Many parents do think of long-termimpairment as a major concern for them, and some parents thinkof it as a bigger concern than death, for example. For someparents knowing this data and knowing the limitations of it andspeaking with a caring neonatologist about it, we would hopethat that would help them in their decision making."

SOURCE: http://bit.ly/17fKYKs

JAMA Pediatrics 2013.