Use of term reference infants in assessing the developmental outcome of extremely preterm infants: Lessons learned in a multicenter study

Abhik Das; Carla M. Bann; Carolyn Marie Petrie Huitema; Marie G. Gantz; K. J. Johnson; Charles E Green; Jon Tyson; Roy J Heyne; Susan R Hintz; Betty R Vohr; Carla M Bann; Abhik Das; Edward F. Bell; Sana Boral Debsareea; Bonnie E Stephens; Marie G. Gantz; Carolyn Marie Petrie Huitema; K. J. Johnson; Kristi Watterberg; Ricardo Mosquera; Myriam A Peralta-Carcelen; E. Costello; Tarah T Colaizy; Nathalie L Maitre; Stephanie Merhar; Ira Adams-Chapman; Janell Fuller; Michelle E Hartley-McAndrew; William F Malcolm; Sarah Winter; Andrea Duncan; Gary J Myer; Stephen D Kicklighter; Myra H Wyckoff; Sara B DeMauro; Anna Maria Hibbs; Barbara Stoll; Waldemar Carlo; Krisa Van Meurs; Matthew A Rysavy; Ravi Patel; Pablo J Sánchez; Abbot Laptook; Michael Cotten; Carl D'Angio; Michele Walsh

Use of term reference infants in assessing the developmental outcome of extremely preterm infants

Lessons learned in a multicenter study

Green, C. E., Tyson, J. E., Heyne, R. J., Hintz, S. R., Vohr, B. R., Bann, C. M., Das, A., Bell, E. F., Debsareea, S. B., Stephens, E., Gantz, M. G., Huitema, C. M. P., Johnson, K. J., Watterberg, K. L., Mosquera, R., Peralta-Carcelen, M., Wilson-Costello, D. E., Colaizy, T. T., Maitre, N. L., ... Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (2023). Use of term reference infants in assessing the developmental outcome of extremely preterm infants: Lessons learned in a multicenter study. Journal of Perinatology, 43(11), 1398-1405. https://doi.org/10.1038/s41372-023-01729-x

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Abstract

OBJECTIVE: Extremely preterm (EP) impairment rates are likely underestimated using the Bayley III norm-based thresholds scores and may be better assessed relative to concurrent healthy term reference (TR) infants born in the same hospital.

STUDY DESIGN: Blinded, certified examiners in the Neonatal Research Network (NRN) evaluated EP survivors and a sample of healthy TR infants recruited near the 2-year assessment age.

RESULTS: We assessed 1452 EP infants and 183 TR infants. TR-based thresholds showed higher overall EP impairment than Bayley norm-based thresholds (O.R. = 1.86; [95% CI 1.56-2.23], especially for severe impairment (36% vs. 24%; p ≤ 0.001). Difficulty recruiting TR patients at 2 years extended the study by 14 months and affected their demographics.

CONCLUSION: Impairment rates among EP infants appear to be substantially underestimated from Bayley III norms. These rates may be best assessed by comparison with healthy term infants followed with minimal attrition from birth in the same centers.

GOV ID: Term Reference (under the Generic Database Study): NCT00063063.