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Neurodevelopmental outcomes of extremely premature infants conceived after assisted conception: a population based cohort study
  1. M E Abdel-Latif1,2,
  2. Barbara Bajuk3,
  3. Meredith Ward4,5,
  4. Ju Lee Oei4,5,
  5. Nadia Badawi6,7,8,
  6. and the NSW and ACT Neonatal Intensive Care Units Audit Group
  1. 1Department of Neonatology, Centenary Hospital for Women and Children, Garran, Australian Capital Territory, Australia
  2. 2School of Clinical Medicine, Australian National University, Woden, Australian Capital Territory, Australia
  3. 3Neonatal Intensive Care Units’ Data Collection, NSW Pregnancy and newborn Services Network, Westmead, New South Wales, Australia
  4. 4Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
  5. 5School of Women's and Children's Heath, University of New South Wales, New South Wales, Australia
  6. 6Grace Centre for Newborn Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
  7. 7Cerebral Palsy Alliance Research Foundation, Notre Dame University, Sydney, Australia
  8. 8Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, New South Wales, Australia
  1. Correspondence to Professor Mohamed E Abdel-Latif, Department of Neonatology, Centenary Hospital for Women and Children, PO Box 11, Woden ACT 2606, Australia; Abdel-Latif.Mohamed{at}act.gov.au

Abstract

Objective To compare neurodevelopmental outcomes of extremely preterm infants conceived after assisted conception (AC) compared with infants conceived spontaneously (non-AC).

Design Population-based retrospective cohort study.

Setting Geographically defined area in New South Wales and the Australian Capital Territory, Australia served by a network of 10 neonatal intensive care units.

Patients Infants <29 weeks’ gestation born between 1998 and 2004.

Intervention At 2–3 years corrected age, 1473 children were assessed with either the Griffiths Mental Developmental Scales or the Bayley Scales of Infant Development.

Main outcome measure Moderate/severe functional disability defined as developmental delay (Griffiths General Quotient or Bayley Mental Developmental Index >2 SD below the mean), cerebral palsy (unable to walk without aids), deafness (bilateral hearing aids or cochlear implant) or blindness (visual acuity <6/60 in the better eye).

Results Mortality and age at follow-up were comparable between the AC and non-AC groups. Developmental outcome was evaluated in 217 (86.5%) AC and 1256 (71.7%) non-AC infants. Using multivariate adjusted analysis, infants born after in-vitro fertilisation at 22–26 weeks’ gestation (adjusted OR 1.79, 95% CI 1.05 to 3.05, p=0.03) but not at 27–28 weeks’ gestation (adjusted OR 0.81, 95% CI 0.37 to 1.77; p=0.59) had higher rate of functional disability than those born after spontaneous conception.

Conclusions AC is associated with adverse neurodevelopmental outcome among high risk infants born at 22–26 weeks’ gestation. This finding warrants additional exploration.

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