Admissions of all gestations to a regional neonatal unit versus controls: 2-year outcome

Authors

  • Brian A Darlow,

    1. Departments of Paediatrics (BAD, M W-W, NM) and Health and Development Study (LJH), University of Otago, and Neonatal Service, Christchurch Women's Hospital (BAD, NA), Christchurch, New Zealand
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  • L John Horwood,

    1. Departments of Paediatrics (BAD, M W-W, NM) and Health and Development Study (LJH), University of Otago, and Neonatal Service, Christchurch Women's Hospital (BAD, NA), Christchurch, New Zealand
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  • M Beth Wynn-Williams,

    1. Departments of Paediatrics (BAD, M W-W, NM) and Health and Development Study (LJH), University of Otago, and Neonatal Service, Christchurch Women's Hospital (BAD, NA), Christchurch, New Zealand
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  • Nina Mogridge RN,

    1. Departments of Paediatrics (BAD, M W-W, NM) and Health and Development Study (LJH), University of Otago, and Neonatal Service, Christchurch Women's Hospital (BAD, NA), Christchurch, New Zealand
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  • Nicola C Austin

    1. Departments of Paediatrics (BAD, M W-W, NM) and Health and Development Study (LJH), University of Otago, and Neonatal Service, Christchurch Women's Hospital (BAD, NA), Christchurch, New Zealand
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Professor Brian Darlow, Department of Paediatrics, Christchurch School of Medicine, University of Otago Christchurch, PO Box 4345, Christchurch, New Zealand. Fax: +64 3 3640747; email: brian.darlow@otago.ac.nz

Abstract

Aims:  To assess neurodevelopmental outcome at 2 years for neonatal intensive care unit (NICU) admissions compared with controls, and to trial a parent-reporting scheme.

Methods:  All infants admitted to the NICU at Christchurch Women's Hospital over a 12-month period and whose parents were domiciled in a defined geographical region were eligible for study, together with every eighth term infant not admitted (to a total of 300). Parents completed a two-page questionnaire on their child's 2nd birthday. All infants <28 weeks gestation and a random 300 NICU admissions and 108 controls underwent a paediatric examination and Bayley II assessment at 2 years of age.

Results:  A total of 387 NICU infants (86% eligible) and 306 controls were enrolled. At 2 years of age, 276 NICU infants (89% survivors) and 94 controls (87%) had some follow up. For infants of <33 weeks, 33–36 weeks, ≥37 weeks gestation and controls, the percentage >1 SD below the mean on the Bayley Mental Development Index scales were 33.3, 36.5, 44.6 and 24.1, respectively (P= 0.03); on the Psychomotor Developmental Index scales were 30.0, 29.1, 41.1 and 19.5 (P= 0.02) and the percentage with any cerebral palsy were 11.1, 2.8, 5.2 and 1.2.

Conclusions:  At 2 years of age, NICU graduates have more developmental problems than controls across a range of measures. In many cases, term NICU graduates have the least favourable outcome. There was only moderate agreement between parents' reporting of moderate or severe developmental disability by means of a questionnaire, compared with professionals (kappa statistic 0.38), with parents tending to underestimate problems.

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