Neurodevelopmental outcome at 2 years in 23 to 26 weeks old gestation infants

Background: Assessment of neurologic and developmental outcome at 2 years age of infants with gestational age (GA) <27weeks, born between 1996-2001. Patients: A total of 110 live-born preterm infants with GA <27weeks. Methods: Main outcome criterions: Neurologic examination (according to Touwen) and classification of cerebral palsy by using the Gross Motor Function Classification System (GMFCS) at the corrected age of 1 and 2 years; assessment of mental and psychomotor development by using the Griffith Mental Development scales at the corrected age of 2 years; growth assessment at birth, I and 2 years. Results: Mortality was 52%. Regular follow up was performed in 48 (91%) of the 53 surviving infants. Neurologic outcome: at 1 year age: 2% nonambulant cerebral palsy, 25% mild neurologic signs and 73% normal; at 2 years age: 4% nonambulant cerebral palsy, 2% ambulant cerebral palsy, 4% mild neurologic signs and 90% normal neurology. Developmental outcome at 2 years age: 40% DQ>-1 SD, 6% DQ between -1 SD and -2 SD (mild delay), 35% DQ between -2 SD and -3 SD (moderate delay) and 19% DQ<-3 SD (severe delay). Overall disability was found in 64%, severe disability in 27% of the infants. Profound growth failure in weight and head circumference <3rd centile at 2 years age was recorded in 39 and 19% of the infants, respectively. Conclusion: Developmental delay is very common in preterm infants < 27 GA and exceeds the number of neurological disabilities (including cerebral palsy).