Beyond survival: 5-year neurodevelopmental follow-up of a cohort of preterm infants in Colombo, Sri Lanka

Abstract

Background: There is a lack of information on long-term neurodevelopmental outcome in preterm neonates in low- and middle-income countries.

Objectives: To describe the developmental attainments of preterm neonates followed up for 5 years and to identify the risk factors for impairment.

Method: A prospective descriptive cohort study was undertaken in neonates of 34 weeks gestation born within a period of 12 months at a single tertiary maternity and neonatal unit in Colombo, Sri Lanka. Infants were assessed for neurodevelopment using the Bayley Infant and Toddler III® Assessments at 6, 12 and 24 months of corrected age and school readiness assessment at 5 years.

Results: Fifty-one infants were assessed at least once, 45 were assessed at 2 years and 39 had a final assessment at 5 years. Neurodevelopmental attainment deteriorated significantly in the cognitive and motor composite scores from 6 to 24 months (p < 0.05). By 5 years the number of children with delay in cognitive, language and motor domains had reduced significantly from 24 months (p < 0.05) but the cognitive skills remained most affected (10/39). At 5 years, 13 of 39 children had a confirmed diagnosis of a neurodevelopmental disorder: eight had attention deficit hyperactivity disorder, three autism spectrum disorder, one cerebral palsy and one visual impairment. Surfactant administration and retinopathy of prematurity were the most significant risks for delayed development at 5 years (p < 0.05).

Conclusion: Deterioration of cognitive and motor composite scores over the first 24 months highlights the need for regular surveillance of premature infants. There was a discrepancy between the diagnosis of neurodevelopmental delay at 24 months and at 5 years. But the notable impact on school readiness skills requires public health initiatives to cater for the needs of these children.

Keywords:

• Prematurity
• neuro-developmental outcomes
• low and middle income countries
• risk factors for developmental delay
• developmental surveillance
• school readiness
• Sri Lanka

Acknowledgments

We are grateful to the nursing staff in the neonatal intensive care unit and special care baby unit at De Soyza Maternity Hospital, Colombo. We also thank Drs Suran Kuruppu, Hasitha Wijeyasundera, Chamara Jayamanne, Janaka Weeragalle and Sagarika Mallawarachchi for data collection and data entry, and Dr Dileepa Ediriweera for statistical input.