Neurodevelopmental Outcomes in Preterm Infants at 18 Months of Corrected Age Following Coronavirus Disease 2019 (COVID-19) Pandemic-Related Neonatal Intensive Care Unit (NICU) Care Changes.

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic led to significant changes in neonatal intensive care unit (NICU) protocols, including restrictions on parental visitation and suspension of kangaroo mother care. These modifications likely impacted preterm infants' neurodevelopmental outcomes. While previous studies have examined the short-term developmental effects of the pandemic, the long-term neurodevelopmental consequences remain unclear. This study aimed to assess the impact of pandemic-related NICU care changes on the neurodevelopmental outcomes of preterm infants at 18 months corrected age in Japan.

METHODOLOGY

This retrospective, single-center study was conducted at a Japanese university hospital and included preterm infants born before and during the COVID-19 pandemic. Eligible infants were those with a gestational age of less than 32 weeks or a birth weight under 1,500 g, who subsequently underwent neurodevelopmental assessment at 18 months of corrected age using the Kyoto Scale of Psychological Development 2001 (KSPD). Infants were categorized into a prepandemic group (born before March 1, 2020) and a pandemic group (born on or after March 1, 2020). To compare demographic and clinical characteristics between the groups, the Mann-Whitney U test was employed for continuous variables and the chi-square test for categorical variables. All statistical analyses were performed using a predefined significance level of p < 0.05.

RESULTS

A total of 44 preterm infants were included (22 per group). While there were no significant differences in birth weight or neonatal morbidities between the groups, the pandemic group had a significantly older gestational age (30 vs. 28 weeks, p = 0.04). KSPD assessments revealed that the pandemic group had significantly lower cognitive-adaptive (80 vs. 92, p = 0.01) and language-social (73 vs. 89, p = 0.04) developmental quotients (DQ) compared with the prepandemic group. Postural-motor DQ was lower in the pandemic group but did not reach statistical significance (82 vs. 98, p = 0.14). To account for potential confounders, an analysis of covariance was conducted, adjusting for gestational age, birth weight, and sex. The adjusted analysis remained consistent with the unadjusted findings, confirming significantly lower cognitive-adaptive DQ (F = 4.83, p = 0.03) and language-social DQ (F = 3.94, p = 0.04) in the pandemic group. Gestational age, birth weight, and sex were not significantly associated with any DQ scores.

CONCLUSIONS

Preterm infants born during the COVID-19 pandemic exhibited significantly lower cognitive-adaptive and language-social DQs at 18 months corrected age than prepandemic infants. These findings suggest that pandemic-related restrictions on parental involvement in the NICU may have potentially influenced neurodevelopment. Further research is needed to explore long-term developmental trajectories and interventions to support optimal outcomes in this vulnerable population.