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Aim: To determine growth, neurological and cognitive development at 5 years of preterm infants with birthweights

Extremely low birth weight (ELBW) infants are prone to impaired neurodevelopment.The aim was to determine long-term neurodevelopmental outcome in ELBW infants after postnatal 17β-estradiol (E2) and progesterone (P) replacement.At 5-yr corrected age, ELBW infants were assessed for standardized cognitive and neurological outcome after postnatal randomized E2 and P replacement or placebo administration.The follow-up examination was performed in a neuropediatric ambulatory care center.Sixty-one of 71 surviving infants (86%) were available for follow-up.Cognitive and neurological outcome was evaluated using the Kaufmann Assessment Battery for Children, the Gross Motor Function Classification Scale, and clinical neurological examination.No significant differences were found between the replacement and placebo groups for the Gross Motor Function Classification Scale, presence of paresis, cerebral palsy, spasticity, and ametropia. However, a significant time-response relationship was found with E2 and P replacement. Every day of treatment reduced the risk for cerebral palsy (P=0.03), spasticity (P=0.01), and ametropia (P=0.01).Postnatal E2 and P replacement may have potential in improving neurodevelopmental outcome in ELBW infants. Larger trials are needed to test this new hypothesis.

OBJECTIVE. Extremely preterm infants are at risk for poor growth and impaired neurodevelopment. The objective of this study was to determine whether intrauterine, early neonatal, or postdischarge growth is associated with neurocognitive and motor-developmental outcome in extremely preterm infants. METHODS. Surviving children who were born between July 1996 and June 1999 at RESULTS. A total of 219 (83%) of 263 long-term survivors were evaluated at a median corrected age of 5.4 years. Increasing SD scores for weight and head circumference from birth to discharge were associated with a reduced risk for an abnormal neurologic examination. Catch-up growth of head circumference from birth to discharge was also associated with a reduced risk for impaired mobility. Weight SD score at birth, an increase of weight SD score from birth to discharge, and an increase of head circumference SD score from discharge to follow-up had an effect on the mental processing composite score. The effects of growth on neurodevelopment were by far exceeded by the consequences of intraventricular and periventricular hemorrhage. CONCLUSIONS. Growth from birth to discharge seemed to be associated with long-term motor development. Cognitive development was associated with intrauterine growth measured as weight at birth, early neonatal weight gain, and postdischarge head circumference growth. Improving particularly early neonatal growth may improve long-term outcome in extremely preterm infants, but the effects of improved growth may only be small.