Correlation between initial neonatal and early childhood outcomes following preterm birth

OBJECTIVE: Neonatal diagnoses are often used as surrogate endpoints for longer-term outcomes. We sought to characterize the correlation between neonatal diagnoses and early childhood neurodevelopment. STUDY DESIGN: We conducted secondary analysis of a multicenter randomized controlled trial of antenatal magnesium sulfate vs placebo administered to women at imminent risk for delivery < 32.0 weeks to prevent death and cerebral palsy in their offspring. Singletons and twins delivering 23.0-33.9 weeks who survived to hospital discharge and had 2-year-old outcome data were included. Those surviving to age 2 years were assessed by trained physicians and the Bayley II Scales of Infant Development Mental Development and Psychomotor Development Indices. Neonatal diagnoses at the time of each baby's initial hospital discharge were examined singly and in combination to determine those most predictive of childhood neurodevelopmental impairment, defined as a childhood diagnosis of moderate/severe cerebral palsy and/or Bayley scores > 2 SD below the mean. Data were analyzed by multiple regression models and area under receiver operating characteristic curves. RESULTS: A total of 1771 children met criteria. Children were delivered at a mean of 29.4 weeks' gestation. In all, 459 (25.9%) had neurodevelopmental impairment. In models controlling for gestational age at delivery, maternal education, maternal race, tobacco/alcohol/drug use during pregnancy, randomization to magnesium, fetal sex, and chorioamnionitis, individual neonatal morbidities were moderately predictive of childhood neurodevelopmental impairment (best model area under receiver operating characteristic curve, 0.68; 95% confidence interval, 0.65-0.71). Combinations of 2, 3, and 4 morbidities did not improve the prediction of neurodevelopmental impairment. CONCLUSION: Approximately 1 in 4 previously preterm children had neurodevelopmental impairment at age 2 years. Prediction of childhood outcomes from neonatal diagnoses remains imperfect.