PC1091: Cognitive Outcomes of High-risk Term and Late Preterm Infants in the NICU

Background: Term and late preterm infants with prolonged hospitalization and life-sustaining interventions in the neonatal intensive care unit (NICU) are vulnerable to neurodevelopmental impairment. This population is inconsistently referred to NICU follow-up programs due to assumptions that their outcomes will be age appropriate. Preschool-age neuropsychological evaluations assess outcomes in this high-risk population but often occur beyond the age for earliest intervention. Results of these evaluations can better inform NICU follow-up inclusion criteria and referrals for therapies. Therefore, the objective of this study is to identify cognitive outcomes and NICU follow-up referral patterns of term and late preterm infants with abnormal preschool-age neuropsychological evaluations.

Methods: Retrospective cohort study including term and late preterm (≥ 34 weeks) infants born between 1/2013-12/2015, admitted to the NICU, and evaluated by neuropsychology between 3-6 years of age. Maternal history, neonatal characteristics, and neuropsychology evaluation results were extracted. Neuropsychology evaluations consisted of assessments of cognitive domains as appropriate for the child’s level of functioning. Scores < 25th %ile were considered below average. An evaluation was deemed abnormal if performance in ≥ 1 neurocognitive domain scored < 2nd %ile indicating an exceptionally low score. Mann Whitney, Chi-Square, and Fisher’s exact tests were used to compare patients with normal vs. abnormal evaluations.

Results: Six percent of the cohort was referred to neuropsychology; 87% with completed evaluations (Fig. 1). Of the patients with completed evaluations, 90% had ≥ 1 abnormal neurocognitive domains (median = 3). No significant maternal characteristics were identified. Diagnoses associated with abnormal cognitive outcomes were ventriculomegaly, hypoxic-ischemic encephalopathy, and neonatal seizure. Of the 61 patients with abnormal evaluations, only 36% were identified as high-risk upon discharge and referred for NICU follow-up or therapies. Median scores for the intellectual ability and language domains were below average, while median score for the motor domain was exceptionally low (Fig. 2).

Conclusion: Term and late preterm infants at high-risk for cognitive delays are inconsistently identified in the NICU and infrequently referred for follow-up programs. However, of those patients referred and evaluated by neuropsychology at preschool-age, the majority had exceptionally low cognitive scores. NICU discharge diagnosis should be a driving factor informing follow-up inclusion criteria and referral for early therapies in this high-risk population.