Premature survivors are at increased risk for impaired neurodevelopmental outcome compared to full terms. These sequelae include cognitive abnormalities, mild fine or gross motor delay, cerebral palsy, vision and hearing losses, impairment increases with decreasing gestational age. Persistence of multiple abnormal neurologic signs in the first 12 to 18 months is ominous. Emergence of other findings (vision impairments, seizures, feeding issues delay of head growth) is associated with poor outcome. MRI is useful in predicting neurodevelopmental outcome at the equivalent of term gestation. Other neonatal complications as; bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, intraventricular hemorrhage, poor growth, presence of congenital anomalies are associated with an increased risk of poor neurodevelopmental outcome. Premature survivors are more likely to have specific psychological and behavioral problems including attention deficit hyperactivity syndrome, general anxiety, and depression. Individuals with birth weights below 1500 g are at greater risk for poor academic performance than those born with normal birthweight because of their impaired cognition, neurosensory defects, and behavioral and psychological problems. Neurodevelopmental outcome is assessed more accurately at school age than in early childhood due to the cognitive recovery over time and lack of accurate predictive assessment tools in early childhood.
Survivors of prematures need to be assessed for neurodevelopmental impairment and, if impairment is present, be referred to educational programs and subspecialty care in order to provide the best possible outcome. ELBW infants without evidence of significant neonatal brain injury can recover when exposed to a nurturing home environment and comprehensive early intervention services.