Prediction of Neurodevelopmental Outcome of Preterm Babies Using Risk Stratification Score.

OBJECTIVES

To study the incidence of major neurodevelopmental disability (NDD) at 1 y age (corrected for prematurity) in a cohort of preterm Indian babies (≤33 wk) and to predict NDD based on perinatal risk factors.

METHODS

This prospective cohort study was conducted at a referral neonatal intensive care unit (NICU) with a developmental follow up clinic in private sector in Kerala, India. The study was conducted for 4.5 y - January 2005 to July 2009. All preterm babies ≤33 wk at birth, discharged from the NICU were included. Pre-defined perinatal and neonatal risk factors known to affect neurodevelopmental outcome were recorded prospectively, in a structured form. Babies were followed to 1 y of age, corrected for prematurity and classified as normal or as having major neurodevelopmental disability (NDD). Major NDD was defined as cerebral palsy or Development Assessment Scale for Indian Infants (DASII) motor /mental score <70 or blindness in one or both eyes or hearing impairment needing hearing aids.

RESULTS

The incidence of major NDD at 1 y age (corrected for prematurity) among the 225 preterm babies was 6.2 %. A clinical score was devised by combining 5 risk factors, gestation ≤28 wk, need for extensive resuscitation at birth, symptomatic hypoglycemia, invasive ventilation for >7 d and abnormal neurosonogram. Scores of 1 to 5 were associated with 4, 6, 10, 25, 100 % risk of major NDD respectively (p < 0.01). The authors could stratify 87.5 % of the babies into low risk (score of 1 or 2) for NDD and 12.5 % into high risk (score 3 or 4 or 5) for major NDD.

CONCLUSIONS

Majority of the preterm babies at lower risk of NDD need less intensive follow up, while those at higher risk (12.5 %) should be guided to more frequent structured follow up and early intervention program.