Antenatal variables associated with severe adverse neurodevelopmental outcome among neonates born at less than 32 weeks

ObjectiveTo determine the association between antenatal factors and severe adverse neurodevelopmental outcome (ANDO) in preterm infants.Study designNeurodevelopmental follow-up was performed in a cohort of babies born at <32.0 weeks’ gestation with birth weight <1500 grams between 1999 and 2006. Logistic regression analysis was used to relate obstetric, perinatal and neonatal ultrasonographic predictors to severe ANDO, defined as cerebral palsy or neurodevelopmental impairment, including sensory damage and adjusted development quotient <70.Results88.6% (195/220) of surviving babies underwent follow up for a median of 24 months (range 12–96); 45 of them (23%) had ANDO, which was severe in 28 (14.3%). Abnormal ultrasonographic findings (intraventricular hemorrhage grades 3 or 4, periventricular leukomalacia, or ventriculomegaly) were observed in 18 cases (9.2%) and they were significantly associated with severe ANDO (OR 11.8 95% CI 4.0–34.0). Only gestational age at delivery (OR 0.80 95% CI 0.66–0.97), but not intrauterine infection, was independently related to severe ANDO. Infants with severe ANDO born before 28 weeks presented lower umbilical artery pH (7.24 ± 0.1 vs 7.31 ± 0.06, p = 0.005) and a significantly higher rate of cesarean delivery (85.7% vs 50%, OR 6 95%CI 1.3–26.3, p = 0.03) compared with infants without severe ANDO.ConclusionGestational age at delivery and low umbilical artery pH at less than 28 weeks, but not intrauterine infection, are independent risk factors for severe ANDO in babies with birth weight <1500 g.