Background: Extremely preterm infants are at higher risk of adverse neurodevelopmental outcome, which may relate to early severe intraventricular hemorrhage (IVH). Previous research from our center demonstrated that enhanced hemodynamic care, guided by targeted neonatal echocardiography (Hemodynamics Screening [HS]), led to decreased mortality and lower rates of IVH and other major morbidities. Whether neonatal HS translates into improved neurodevelopmental outcome following hospital discharge remains unknown.
Objective: To evaluate the impact of early HS on the risk of adverse neurodevelopmental outcome during the first 2 years of life.
Methods: All inborn premature infants born less than 27 weeks gestational age who underwent universal HS (2018-2022) will be identified and compared with a historical cohort (2013-2017) at the University of Iowa. Prospectively collected data on pregnancy complication, delivery, maternal risk factors, and neonatal variables will be compared. To avoid survival bias, the primary outcome will be a composite of death or neurodevelopmental impairment (NDI) at 22-26 months corrected age. The primary outcome NDI will be defined at 2 SD below the mean on cognitive composite on the Bayley Infant Scales of Development (3rd or 4th edition) and/or moderate to severe cerebral palsy. Logistic regression modeling will adjust for gestational age, multiple gestation, antenatal steroid exposure, sex, maternal education, and small-for-gestational-age status. Secondary analysis will compare individual components of the Bayley, blindness, deafness, cerebral palsy, and Child Behavior Checklist. This study was approved by the institutional research ethics board.