Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Scheuchenegger, A.
Moderate and late preterm infants: a prospective analysis of neonatal morbidities, causes and rates of rehospitalizations within the first year of life, and neurodevelopmental outcome at 12 months
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medizinische Universität Graz; 2022. pp. 129
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- Autor*innen der Med Uni Graz:
- Scheuchenegger Anna Birgitta
- Betreuer*innen:
- Eber Ernst
- Einspieler Christa
- Resch Bernhard
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- Abstract:
- Background and Aim Moderate and late preterm (MLPT) infants account for nearly 85 % of all preterm infants. It is crucial to identify those MLPT infants who are at risk for an adverse outcome. However, the current knowledge on morbidities and neurodevelopment within the first year is still limited. This thesis therefore aims to investigate neonatal morbidities, General Movements (GMs), rehospitalization rates and neurodevelopment of MLPT infants during the first year. Methods This is a longitudinal follow-up study of a group of MLPT infants at a tertiary care hospital. Demographic and clinical characteristics regarding morbidity rates, lengths of stay and rates of as well as reasons for rehospitalization were recorded. GMs were analyzed globally and detailed from one video recording during the neonatal period and a second video recording at 3-4 months post-term age. Videos were rated based on the Prechtl General Movement Assessment and detailed optimality scores (General Movement Optimality Score, GMOS; Motor Optimality Score, MOS) were calculated. Neurodevelopment was assessed at the age of one year with a standardized assessment. Results The study population comprised 215 infants (58% males; 60% singletons; 99 moderate preterm (MPT) and 116 late preterm (LPT) infants) with a median gestational age of 34 weeks and birth weight of 2100 grams; 20% of them were small for gestational age. MPT infants more often had a diagnosis of mild respiratory distress syndrome (26% vs. 13%, p < 0.01) and feeding problems with longer need for nasogastric tube feeding (median 9.5 vs 4.2 days, p < 0.01) and parenteral nutrition (3.5 vs. 2.7 days, p < 0.01), and longer duration of stay at either NICU (10.6 vs. 3.7 days; p < 0.01) or hospital (13 vs. 11 days; p < 0.01). Fifty-two infants (24.3%) were hospitalized at 67 occasions without differences regarding readmission rates and causes between groups. Median age at readmission was 3 months, median stay 4 days. The most common diagnosis was respiratory illness (43.3%). The rate of normal GMA within the neonatal period was 45% for MPT and 30 % for LPT infants (37.7% for MLPT infants). 99% had Fidgety Movements (FMs) at 3-4 months post-term age. The GMOS ranged from 12 to 42 (median = 31; IQR 25 - 38.5). The MOS ranged from 12 to 28 (median = 24; IQR 23 - 26) and was reduced in 42% of all infants (e.g., below 25). GMOS and MOS did not differ in MPT and LPT infants. GMs during neonatal period did not correlate with the MOS. The effects of sex, multiple birth, postmenstrual age at assessment, and particular neonatal morbidities or complications varied between gestational age groups. 87.5% of all infants reached normal results at the assessment at the age of one year. Conclusion MPT infants had more neonatal morbidities diagnosed, but the same rehospitalization rates than LPT infants. The MLP infants of our study showed a high rate of occurrence of abnormal GMs during neonatal age. All infants except one had FMs. However, in the detailed assessment we found a high number of reduced MOS. None of our children were diagnosed as having severe global developmental delay. However, since 1 in 8 children showed a moderate delay at the corrected age of 1 year, our results suggest that the development of MLPT infants should be monitored after discharge.