Neurodevelopmental surveillance in the first 2 years after extremely preterm birth: evidence, challenges, and guidelines.

During the past decade, major advances in maternal-fetal medicine and neonatology have resulted in unprecedented survival of very preterm babies. These babies represent a small fraction of infants born preterm, but present significant challenges with respect to respiratory, nutritional, and developmental vulnerabilities. Several efforts involving the UK, US, Canada, Australia, and the Netherlands have provided information on regional trends over time with respect to neonatal morbidities and neurodevelopmental outcomes through the first two years of life. Historically gross and fine motor, cognitive and communicative skills, vision and hearing performance have been the focus of assessment. Indicators of major neurodevelopmental disabilities at 2 years have included presence of severe neurosensory impairment, i.e. cerebral palsy, sensorineural hearing loss requiring aides, and blindness. In addition cognitive developmental disability has been generally defined as a Bayley MDI or developmental quotient <70, i.e. lower than 2 standard deviations below the mean. However these outcomes cannot reliably capture trajectories of resiliency as well as more complex developmental challenges in the domains of coordination, perception, attention, communication, and learning. Recently tools have become available for assessing functional status in gross motor, communicative, adaptive and social-emotional behaviours of imitation, regulation, and play. This review will describe the major progress in assessing early neurodevelopmental status of vulnerable survivors receiving new biomedical technologies, highlight challenges, and propose guidelines based on current best evidence.