Assessment of neurodevelopmental outcomes in preterm infants using risk stratification score

Objectives: Preterm birth, defined as delivery occurring before 37 weeks gestation, poses a significant public health challenge, as an increasing number of infants who survive face neurodevelopmental disabilities. Preterm infants face various health challenges, including anaemia, hyperbilirubinaemia, feeding and respiratory difficulties, retinopathy and intracranial haemorrhage, which often lead to long-term cognitive, learning and behavioural impairments due to structural brain abnormalities. (1) To study risk stratification tools based on intrauterine and neonate insult. (2) To study and predict major neuro-developmental disability like cerebral palsy, mental retardation, blindness, deafness at 1 year of age. Material and Methods: The study included 30 preterm infants, categorised by risk levels, after obtaining ethical clearance and parental consent. Developmental follow-up assessments were adjusted for prematurity and conducted using tools such as the Amiel-Tison angle (ATA), scarf sign, Denver developmental screening test (DDST) and Vineland social maturity scale (VSMS). Visual and hearing assessments were checked for retinopathy and deafness. Primary outcomes at 1 year included death or major neurodevelopmental delays, such as cerebral palsy, mental impairment, blindness and profound hearing loss. Results: In this study of 30 preterm infants, 83% weighed over 1.5 kg with a mean birth weight of 1.73 kg, and amongst those under 1.5 kg, 80% had abnormal developmental outcomes. The mean gestational age was 32 ± 1 weeks. Major neurodevelopmental delays (NDD), including cerebral palsy and global developmental delay, was observed in 16.6% of the infants, while 30% experienced minor NDD. Preterms with major NDD had higher intervention needs, with 40% requiring positive pressure ventilation and intubation, and 20% requiring chest compressions, 26.6% having abnormal ATAs. Statistically significant perinatal risk factors for poor neurodevelopmental outcomes included extreme prematurity (≤32 weeks), birth weight (<1.7 kg), need for resuscitation and prolonged ventilation (>7 days). Conclusion: The study identified extreme prematurity, low birth weight, need for resuscitation and prolonged ventilation as key predictors of poor neurodevelopmental outcomes in preterm infants. Infants were stratified into low and high-risk groups to plan follow-up intensity and early intervention. Tools such as ATA, DDST, and VSMS aid in the early detection of neurodevelopmental disabilities, emphasising the importance of standardised follow-up programmes in neonatal units to improve outcomes for high-risk infants.