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Title Gender differences in neurodevelopmental outcomes in very low birth weight infants at corrected age of 18-24 months and 3 years of age
Author 김유진, 박혜원
작성자 김유진
Background Very low birth infants are associated with a high risk of mortality and long-term morbidities, including neurodevelopmental impairments. Beyond the risks associated with prematurity itself, a growing body of literature suggests that male preterm infants are at a greater risk of adverse short-term outcomes. According to Shim et al., male preterm infants had higher odds of developing bronchopulmonary dysplasia (BPD) and periventricular leukomalacia (PVL) compared to female infants. In addition, multiple large cohort studies, including data from the NICHD Neonatal Research Network (NRN) and the EPICure study, have demonstrated that male sex is independently associated with higher rates of cerebral palsy (CP), cognitive delay, and overall neurodevelopmental impairment, even after adjusting for gestational age and other neonatal risk factors. However, recent meta-analytic evidence has challenged the consistency of these findings. A meta-analysis conducted by Christians et al., found no significant sex differences in the impact of prematurity or low birth weight on cognitive, internalizing, or externalizing outcomes, suggesting that both sexes are similarly vulnerable to neurodevelopmental risks associated with preterm births. This highlights the ongoing debate over the extent and consistency of sex-based disparities in developmental outcomes.
Aim / Hypothesis Aim - To assess sex-specific differences in neurodevelopmental outcomes at 18-24 months corrected age and evaluate whether these differences persist at 3 years of age Hypothesis - We hypothesize that male and female preterm infants differ in their risk of neurodevelopmental impairment among preterm infants.
Inclusion Criteria Very low birth weight infants who were registered in the Korean Neonatal Network (KNN) database
Exclusion Criteria 1) who died in the delivery room or operating room 2) with major congenital malformations 3) without follow-up data
Study Design Statistical methods 1) Descriptive statistics of demographic characteristics of each population - chi-square test or Fisher’ exact test for categorial variables - Student’s t-test or Mann-Whitney U test for continuous variables 2) Univariate analysis for survival without NDI in different sex populations - binary outcomes : Odds ratio (OR), 95% confidence interval (CI) using chi-square test - Bayley scores : mean difference, 95% CI using t-test or Mann-Whitney U test 3) Multivariate logistic regression to examine the association between sex and survival without NDI, adjusting for potential confounders such as gestational age, birth weight, IVH, PVL, BPD, NEC, sepsis, and ROP. - adjusted OR, 95% CI 4) Subgroup and sensitivity analyses among infants born at < 28 weeks’ gestation
Primary Outcomes Survival without neurodevelopmental impairment NDI (neurodevelopmental impairment): more than one of below 1) on antiepileptic drugs 2) vision impairment 3) hearing impairment 4) cerebral palsy 5) Bayley Scales - BSID-II (MDI, PDI), score <70 - BSDI-III (cognitive, language, motor), composite score < 85
Secondary Outcomes and Definitions Severity of NDI In-hospital morbidities (RDS, BPD, severe IVH, PVL, NEC, ROP, sepsis)
Protocols Following the study design described above
Funding None

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