The impact of VLBW birth varies with child medical risk status, age, and developmental outcome. Follow-up programs should incorporate psychological screening and support services for mothers of VLBW infants in the immediate postnatal period, with monitoring of mothers of high-risk VLBW infants.

No abstract

Objective-Bronchopulmonary dysplasia (BPD) is now the leading cause of lung disease in US infants. In a large regional cohort, we tested the hypothesis that despite innovations in neonatal care, very low birth weight (VLBW) infants (<1500 g) with BPD had poorer developmental outcomes than nonaffected infants during the first 3 years of life, and that BPD predicted poorer outcome beyond the effects of other risk factors.Methods-Three groups of infants (122 with BPD, 84 VLBW without BPD, and 123 full-term) were followed longitudinally to 3 years of age with the Bayley Scales of Mental and Motor Development. Comparison groups of VLBW infants without BPD and full-term infants did not differ in sex, race, or socioeconomic status. Statistical analyses included hierarchical and stepwise multiple regression.Results-Infants with BPD performed more poorly at all ages. By 3 years, cognitive and/or motor development was in the range of retardation (<70 standard score) for 21% to 22% of infants with BPD. In multiple regression analyses controlling for socioeconomic and neonatal risk conditions, BPD had an independent negative effect on motor outcome at 3 years. Neurologic risk, a summary measure of neurologic problems other than intraventricular hemorrhage, and the presence of BPD independently predicted motor delay. By 3 years, social class, race, and neurologic risk predicted mental outcome, suggesting that the specific effects of BPD are primarily on the motor domain.Conclusions-In VLBW infants, BPD predicts poorer motor outcome at 3 years, after control for other risks. Cohorts of infants with BPD also had higher rates of mental retardation, associated Copyright © 1997 with greater neurologic and social risk. These findings underscore the need for intensive prevention and habilitation efforts for this growing group of VLBW survivors, as well as investigation into the potential role of BPD in the higher rates of learning disabilities in VLBW cohorts at school age.Improved survival rates for smaller, sicker, very low birth weight (VLBW) infants related to advances in neonatal intensive care have resulted in a corollary increase in incidence of bronchopulmonary dysplasia (BPD). 1 BPD, virtually unknown a generation ago, is now the third leading cause of chronic lung disease in children, and the leading cause of lung disease in infants in the United States, 2,3 with >7000 infants diagnosed yearly.BPD is the term used to describe the clinical, radiographic, and pathologic sequelae of prolonged mechanical ventilation occurring in the lungs of some newborn infants. 1 BPD most often occurs in ventilated preterm infants and is inversely related to gestational age. 4 Pulmonary immaturity, oxygen toxicity, and barotrauma are paramount in the etiology of BPD. 4,5 Previous studies addressing developmental outcome for infants with BPD have been inconsistent in their findings, with many reporting poorer growth and developmental outcomes and greater evidence of neurologic problems, particularly cerebral palsy. [5][6][7][8][9][...

Our 20-year experience with 1239 very low birth weight infants suggests strongly that the late-onset, slow, continuous drip feeding protocol and avoidance of indomethacin and early dexamethasone treatment contribute to the prevention of necrotizing enterocolitis.