Increased Risk of Adverse Neurological Development for Late Preterm Infants

Objective

To assess the risks of moderate prematurity for cerebral palsy (CP), developmental delay/mental retardation (DD/MR), and seizure disorders in early childhood.

Study design

Retrospective cohort study using hospitalization and outpatient databases from the Northern California Kaiser Permanente Medical Care Program. Data covered 141 321 children ≥30 weeks born between Jan 1, 2000, and June 30, 2004, with follow-up through Jun 30, 2005. Presence of CP, DD/MR, and seizures was based on International Classification of Diseases, Ninth Revision codes identified in the encounter data. Separate Cox proportional hazard models were used for each of the outcomes, with crude and adjusted hazard ratios calculated for each gestational age group.

Results

Decreasing gestational age was associated with increased incidence of CP and DD/MR, even for those born at 34 to 36 weeks gestation. Children born late preterm were >3 times as likely (hazard ratio, 3.39; 95% CI, 2.54-4.52) as children born at term to be diagnosed with CP. A modest association with DD/MR was found for children born at 34 to 36 weeks (hazard ratio, 1.25; 95% CI, 1.01-1.54), but not for children in whom seizures were diagnosed.

Conclusions

Prematurity is associated with long-term neurodevelopmental consequences, with risks increasing as gestation decreases, even in infants born at 34 to 36 weeks.

Abbreviations: CP, Cerebral palsy, DD/MR, Developmental delay or mental retardation, ICD-9 CM, International Classification of Diseases, Ninth Revision, Clinical Modification, KPMCP, Kaiser Permanente Medical Care Program, LGA, Large for gestational age, SGA, Small for gestational age