Background Preterm infants are at risk of neurodevelopmental delay, but data on long-term outcomes in low-income and middle-income countries remain scarce.
Objectives To examine neurodevelopment using Bayley Scales of Infant and Toddler Development-3rd edition (Bayley-III) and neurological findings in 2-year-old preterm infants, and to compare with healthy Vietnamese infants. Further, to assess factors associated with neurodevelopmental impairment.
Design and setting Cohort study to follow up preterm infants discharged from a neonatal intensive care unit (NICU) of a tertiary children’s hospital in Vietnam.
Participants Infants born at <37 weeks of gestational age.
Main outcomes Bayley-III assessment and neurological examination at 2-year corrected age (CA) compared with healthy Vietnamese infants.
Results Of 294 NICU preterm infants, Bayley-III scores of all 184/243 (76%) survivors at 2 years CA were significantly lower than those of healthy Vietnamese peers in all three domains: cognition (mean (SD): 84.5 (8.6) vs 91.4 (7.5), p<0.001), language (mean (SD): 88.7 (12.5) vs 95.9 (11.9), p<0.001) and motor (mean (SD): 93.1 (9.0) vs 96.8 (9.3), p=0.003). The mean differences in Bayley-III scores between preterm and healthy Vietnamese infants were −6.9 (−9.1 to −4.7), −7.2 (−10.5 to −3.8) and −3.7 (−6.1 to −1.2) for cognitive, language and motor scores, respectively. The prevalence of neurodevelopmental impairment was 17% for cognitive, 8% for language and 4% for motor performance. In total, 7% were diagnosed with cerebral palsy. Higher maternal education was positively associated with infant neurodevelopment (OR 0.32, 95% CI 0.11 to 0.94).
Conclusions Vietnamese preterm infants in need of neonatal intensive care showed poor neurodevelopment at 2 years. Higher maternal education was positively associated with infant neurodevelopment. Standard follow-up programmes for preterm infants should be considered in low-resource settings.
- preterm infant
- intensive care
- Bayley scale
- low resource setting
- middle-income country
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Contributors This study was conceptualised by CHTD, SS, BW, FKP, AYK and MLB. Grant funding to support the salaries of the Bayley team of assessors and the cost of the Bayley licenses for the study was obtained by SS, BW and FKP. Clinical assessments and neurological examinations were performed by CHTD. Bayley assessments were performed by the Bayley team, trained and supervised by PNT and SS. Data were analysed by CHTD, HC and MLB. CHTD, AYK, FKP and MLB wrote the manuscript with input from all authors. All authors read and approved the final version of the manuscript.
Funding Laerdal foundation, DANIDA and Wellcome Trust Strategic Award to Oxford University Clinical Research Unit, reference number 106680/B/14/Z.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.
Patient consent for publication Parental/guardian consent obtained.
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