Neurodevelopmental impairment and morbidity patterns across two epochs among extremely preterm infant survivors in Australia and New Zealand

OBJECTIVE: To evaluate neurodevelopmental outcomes at 2-3 years of age among survivors of extremely preterm infant (EPI). DESIGN AND SETTING: Analysis of prospectively collected Australian and New Zealand Neonatal Network data on infants born <28 weeks' gestation between 2010 and 2019. MAIN OUTCOME: The prevalence of neurodevelopmental impairment (NDI), defined as any moderate to severe cerebral palsy (CP), sensory impairment or developmental delay (score <70) at 2-3 years of age was determined. Epoch comparisons (2010-204 vs 2015-2019) and the impact of major morbidity on NDI were examined, adjusting for maternal age, antenatal steroids, gestational age, Apgar score, admission temperature, sex and breast milk feeding. RESULTS: Of 6617 EPIs, 15.5% had NDI. Developmental delay was most prevalent (14.5%), including language (11.1%), motor (5.9%), cognitive (5.7%) domains, followed by CP (3.2%), deafness (1.4%) and blindness (0.4%). Compared with infants without morbidity, adjusted odds of NDI increased with one (adjusted OR (aOR) 1.50, 95% CI 1.21 to 1.84), two (aOR 2.09, 95% CI 1.60 to 2.53) and three or more coexisting morbidities (aOR 3.56, 95% CI 2.73 to 4.65). Between epochs, bronchopulmonary dysplasia increased by 6.9% and retinopathy of prematurity by 3.8%, alongside a rise in developmental delay (10.3% to 17.8%), contributing to a 6.6% absolute increase in NDI. Survivors born at 22-23 weeks had the highest NDI rates, increasing from 23.0% to 26.4%. CONCLUSION: NDI rates among EPI increased over time and were associated with increasing multiple morbidities. Although changes in EPIs survival patterns may have contributed to these trends, reducing neonatal morbidities and strengthening neuroprotective care remain priorities.