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Determinants of developmental outcomes in a very preterm Canadian cohort
  1. Anne Synnes1,
  2. Thuy Mai Luu2,
  3. Diane Moddemann3,
  4. Paige Church4,
  5. David Lee5,
  6. Michael Vincer6,
  7. Marilyn Ballantyne7,
  8. Annette Majnemer8,
  9. Dianne Creighton9,
  10. Junmin Yang4,
  11. Reginald Sauve9,
  12. Saroj Saigal10,
  13. Prakesh Shah4,
  14. Shoo K Lee4
  15. on behalf of the Canadian Neonatal Network and the Canadian Neonatal Follow-Up Network
    1. 1Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
    2. 2Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
    3. 3Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
    4. 4Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
    5. 5Department of Pediatrics, University of Western Ontario, London, Ontario, Canada
    6. 6Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
    7. 7Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
    8. 8McGill University Health Centre, Montréal, Quebec, Canada
    9. 9Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
    10. 10McMaster University, Hamilton, Ontario, Canada
    1. Correspondence to Dr Anne Synnes, Room 1R13, BC Women's Hospital and Health Centre, 4500 Oak St, Vancouver, BC, Canada V6H 3V4; asynnes{at}cw.bc.ca

    Abstract

    Objectives Identify determinants of neurodevelopmental outcome in preterm children.

    Methods Prospective national cohort study of children born between 2009 and 2011 at <29 weeks gestational age, admitted to one of 28 Canadian neonatal intensive care units and assessed at a Canadian Neonatal Follow-up Network site at 21 months corrected age for cerebral palsy (CP), visual, hearing and developmental status using the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III). Stepwise regression analyses evaluated the effect of (1) prenatal and neonatal characteristics, (2) admission severity of illness, (3) major neonatal morbidities, (4) neonatal neuroimaging abnormalities, and (5) site on neurodevelopmental impairment (NDI) (Bayley-III score < 85, any CP, visual or hearing impairment), significant neurodevelopmental impairment (sNDI) (Bayley-III < 70, severe CP, blind or hearing aided and sNDI or death.

    Results Of the 3700 admissions without severe congenital anomalies, 84% survived to discharge and of the 2340 admissions, 46% (IQR site variation 38%–51%) had a NDI, 17% (11%–23%) had a sNDI, 6.4% (3.1%–8.6%) had CP, 2.6% (2.5%–13.3%) had hearing aids or cochlear implants and 1.6% (0%–3.1%) had a bilateral visual impairment. Bayley-III composite scores of <70 for cognitive, language and motor domains were 3.3%, 10.9% and 6.7%, respectively. Gestational age, sex, outborn, illness severity, bronchopulmonary dysplasia, necrotising enterocolitis, late-onset sepsis, retinopathy of prematurity, abnormal neuroimaging and site were significantly associated with NDI or sNDI. Site variation ORs for NDI, sNDI and sNDI/death ranged from 0.3–4.3, 0.04–3.5 and 0.12–1.96, respectively.

    Conclusion Most preterm survivors are free of sNDI. The risk factors, including site, associated with neurodevelopmental status suggest opportunities for improving outcomes.

    • prematurity
    • impairments
    • Outcomes research

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    Footnotes

    • Collaborators Canadian Neonatal Network Investigators: Prakesh S Shah, MD, MSc (director, Canadian Neonatal Network and site investigator), Mount Sinai Hospital, Toronto, Ontario; Adele Harrison, MD, MBChB, Victoria General Hospital, Victoria, British Columbia; Anne Synnes, MDCM, MHSC, and Joseph Ting, MD, British Columbia Women's Hospital, Vancouver, British Columbia; Wendy Yee, MD, Foothills Medical Centre, Calgary, Alberta; Khalid Aziz, MBBS, MA, MEd, and Jennifer Toye, MD, Royal Alexandra Hospital and University of Alberta Hospital, Edmonton, Alberta; Zarin Kalapesi, MD, Regina General Hospital, Regina, Saskatchewan; Koravangattu Sankaran, MD, MBBS, and Sibasis Daspal, MD, Royal University Hospital, Saskatoon, Saskatchewan; Mary Seshia, MBChB, Winnipeg Health Sciences Centre, Winnipeg, Manitoba; Ruben Alvaro, MD, St Boniface General Hospital, Winnipeg, Manitoba; Sandesh Shivananda, MBBS, MD, DM, Hamilton Health Sciences Centre, Hamilton, Ontario; Orlando Da Silva, MD, MSc, London Health Sciences Centre, London, Ontario; Chukwuma Nwaesei, MD, Windsor Regional Hospital, Windsor, Ontario; Kyong-Soon Lee, MD, MSc, Hospital for Sick Children, Toronto, Ontario; Michael Dunn, MD, Sunnybrook Health Sciences Centre, Toronto, Ontario; Nicole Rouvinez-Bouali, MD, Children's Hospital of Eastern Ontario and Ottawa General Hospital, Ottawa, Ontario; Kimberly Dow, MD, Kingston General Hospital, Kingston, Ontario; Ermelinda Pelausa, MD and Lajos Kovacs MD, Jewish General Hospital, Montréal, Québec; Keith Barrington, MBChB, Hôpital Sainte-Justine, Montréal, Québec; Christine Drolet, MD, and Bruno Piedboeuf, MD, Centre Hospitalier Universitaire de Québec, Sainte Foy Québec; S Patricia Riley MD and Martine Claveau, RN, Montreal Children's Hospital and Daniel Faucher MD, Royal Victoria Hospital (latter two now merged as McGill University Health Centre), Montréal, Québec; Valerie Bertelle, MD, and Edith Masse, MD, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec; Roderick Canning, MD, Moncton Hospital, Moncton, New Brunswick; Hala Makary, MD, Dr Everett Chalmers Hospital, Fredericton, New Brunswick; Cecil Ojah, MBBS, and Luis Monterrosa, MD, Saint John Regional Hospital, Saint John, New Brunswick; Wayne Andrews MD and Akhil Deshpandey, MD, MBBS, Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland; Doug McMillan MD and Jehier Afifi, MB BCh, MSc, IWK Health Centre, Halifax, Nova Scotia; Shoo K Lee, MBBS, PhD (chairman, Canadian Neonatal Network), Mount Sinai Hospital, Toronto, Ontario. Canadian Neonatal Follow-Up Network Investigators: Thevanisha Pillay, MD, Victoria General Hospital, Victoria, British Columbia; Anne Synnes, MDCM, MHSC, British Columbia Women's Hospital, Vancouver, British Columbia; Reg Sauvé, MD, MPh, Alberta's Children's Hospital, Foothills Medical Centre, Calgary, Alberta; Amber Reichert, MD, Glenrose Rehabilitation Hospital, Edmonton, Alberta; Jaya Bodani, MD, Regina General Hospital, Regina, Saskatchewan; Koravangattu Sankaran, MD, Royal University Hospital, Saskatoon, Saskatchewan; Diane Moddemann, MD, Winnipeg Health Sciences Centre, St Boniface General Hospital, Winnipeg, Manitoba; Chukwuma Nwaesei, MD, Windsor Regional Hospital, Windsor, Ontario; Thierry Daboval, MD, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Kimberly Dow, Kingston General Hospital, Kingston, Ontario; David Lee, MD, Children's Hospital London Health Sciences Centre, London, Ontario; Linh Ly, MD, Hospital for Sick Children, Toronto, Ontario; Edmond Kelly, MD, Mount Sinai Hospital, Toronto, Ontario; Salhab el Helou, MD, Hamilton Health Sciences Centre, Hamilton, Ontario; Paige Church, MD, Sunnybrook Health Sciences Centre, Toronto, Ontario; Ermelinda Pelausa, MD, Jewish General Hospital, Montréal, Québec; S Patricia Riley, MD, Montréal Children's Hospital, Royal Victoria Hospital, Montréal, Québec; Francine Levebvre, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec; Charlotte Demers, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec; Sylvie Bélanger, MD, Centre Hospitalier Universitaire de Québec, Québec City, Québec; Roderick Canning, MD, Moncton Hospital, Moncton, New Brunswick; Luis Monterrosa, MD, Saint John Regional Hospital, Saint John, New Brunswick; Hala Makary, MD, Dr Everett Chalmers Hospital, Fredericton, New Brunswick; Michael Vincer, MD, IWK Health Centre, Halifax, Nova Scotia; Phil Murphy, Charles Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland.

    • Contributors AS, the founding director of the Canadian Neonatal Follow-Up Network, conceptualised and implemented the study, wrote the initial manuscript and approved the final manuscript as submitted. JY performed the statistical analyses, reviewed and approved the final manuscript as submitted. TML, DM, PC, DL, MV, MB, AM and DC are Canadian Neonatal Follow-up Network steering committee members who contributed to the implementation of this study, reviewed and revised the study protocol and the final manuscript and approved the final manuscript as submitted. RS and SS are Canadian Neonatal Follow-up Network founding steering committee members who obtained funding, contributed to the implementation of this study, reviewed and revised the final manuscript and approved the final manuscript as submitted. PS, the director of the Canadian Neonatal Network, reviewed and revised the study protocol and the final manuscript, supervised the data analyses and approved the final manuscript as submitted. SKL, the founding director of the Canadian Neonatal Network and the Maternal-Infant Care Network, is the principal investigator on the Canadian Institutes of Health Research (CIHR) Team in Maternal-Infant Care which funded the Canadian Neonatal Follow-Up Network and reviewed and revised the final manuscript and approved the final manuscript as submitted. All authors take responsibility for all aspects of the work presented in this paper, including the accuracy and integrity of the data analyses.

    • Funding This work was supported by the CIHR through a grant to the CIHR Team in Maternal-Infant Care (CTP 87518). The study coordinating centre, the Maternal-Infant Care Research Centre, is supported by a programme funding from the Ontario Ministry of Health and Long-Term Care. In addition, participating sites contributed additional funding for patient outcome assessments.

    • Competing interests None declared.

    • Ethics approval University of British Columbia Children's and Women's Research Ethics Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The privacy impact assessment for the Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada, has not approved any data to leave the coordinating site.

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