Risks of neurodevelopment impairments in children born moderately preterm

About the risks of neurodevelopment impairments in children born moderately preterm, results from a large population-based cohort study based on Swedish national data.
Published in BMJ 2024 (https://www.bmj.com/content/384/bmj-2023-075630)

The slides are/were presented at the EAPS meeting in Vienna, Oct 2024 (https://eaps2024.kenes.com/)

1. Risks of neurodevelopment impairments
in children born moderately preterm
Stefan Johansson, MD PhD
consultant neonatologist, Sachs’ Children and Youth Hospital
associate professor, Clinical Epidemiology Division (KEP), Karolinska Institutet
Stockholm, Sweden
[email protected] linkedin.com/in/johansson247@[email protected]

2. Moderately preterm infants –many and overlooked
•Children born moderately preterm
(32-36 weeks) represent a
substantial healthcare burden
•Reports suggest higher risks of later
impairments, but few population-
based studies have looked into
long term outcomes in detail

3. Large study with long follow-up
✓Cohort study based on Swedish health care registries
✓1.3 million liveborn infants ≥32 weeks, 1998-2012
✓Analyses controlled for important confounders (DAG on following slide)
✓The primary outcomes (ICD-codes) diagnosed up to 16y of age:
omotor, cognitive, epileptic, hearing, and visual impairments
ocomposite of any neurodevelopmental impairment
BMJ 2024;384:e075630

5. Rates of any neurodevelopmental impairment (%)
11.1
8.0
6.3
5.6
32-33 WEEKS 34-36 WEEKS 37-38 WEEKS 39-40 WEEKS (REF)

6. Rates of impairments (per 10 000 person-years)
0
5
10
15
20
25
30
35
40
MOTOR COGNITIVE EPILEPTIC VISUAL HEARING
32-33 weeks 34-36 weeks 37-38 weeks 39-40 weeks (ref)

7. Risks of impairments (HR, 95% CI)
MOTOR COGNITIVE EPILEPTIC VISUAL HEARING
32-33 w
4.7
(4.0-5.6)
1.7
(1.5-2.0)
1.9
(1.6-2.3)
1.7
(1.5-2.0)
1.4
(1.2-1.6)
34-36 w
1.9
(1.7-2.1)
1.3
(1.2-1.4)
1.2
(1.1-1.4)
1.4
(1.3-1.5)
1.2
(1.1-1.2)
37-38 w
1.3
(1.2-1.4)
1.1
(1.1-1.2)
1.1
(1.0-1.1)
1.1
(1.0-1.1)
1.0
(1.0-1.1)
39-40 w ref. ref. ref. ref. ref.

8. Take home messages
•When children born moderately preterm (32-36w) grow up,
they have higher risks of neurodevelopment impairments
compared to term-born peers
•Risks are lower compared to risk for children born very preterm (<32w)
•However, children born moderately preterm comprise the largest group of
children with a history of prematurity.
•Consequently, their developmental trajectories deserves more attention

9. ICD-codes (backup slide)
Karolinska Institutet - a medical university 20/09/2024 10