Long-Term Neurodevelopmental Outcomes in Very Preterm Infants with Severe Birth Asphyxia: A Multi-Center Cohort Study

Objective: This study aimed to investigate the long-term neurodevelopmental outcomes in very preterm infants (<32 weeks of gestation) who experienced severe birth asphyxia, with a focus on cognitive, motor, and language development at 36 months corrected age. Methods: A multi-center cohort design was employed across 10 tertiary care centers with specialized neonatal intensive care units (NICUs). The study included 150 infants diagnosed with severe birth asphyxia, defined by an Apgar score of less than 5 at 5 minutes post-birth and the presence of moderate to severe hypoxic-ischemic encephalopathy (HIE). Longitudinal assessments were conducted using the Bayley Scales of Infant and Toddler Development (3rd edition) at 12-, 24-, and 36-months corrected age. Multivariate regression models were used to analyze the association between clinical factors and neurodevelopmental outcomes. Results: At 36 months corrected age, 45% of the infants exhibited normal development, 30% had mild delays, and 25% had severe delays across cognitive, motor, and language domains. Cerebral palsy was diagnosed in 18% of the cohort, with spastic diplegia being the most common form. Sensory impairments were identified in 18% of the infants, with 10% exhibiting visual deficits and 8% auditory impairments. Severe HIE was a significant predictor of poor neurodevelopmental outcomes (OR: 3.5, 95% CI: 2.1-5.8), along with lower gestational age (OR: 2.3, 95% CI: 1.5-3.4) and male gender (OR: 1.8, 95% CI: 1.2-2.7). Conclusions: The findings underscore the significant risk of long-term neurodevelopmental impairments in very preterm infants with severe birth asphyxia. Early identification of at-risk infants and targeted interventions are crucial to improving outcomes in this vulnerable population.