A Longitudinal Study of Developmental Outcome of Infants With Bronchopulmonary Dysplasia and Very Low Birth Weight

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][...

Effects of Maternal Employment and Prematurity on Child Outcomes in Single Parent Families

“…Preterm children in this sample were born later than those in the studies by Hack et al and Brandt et al Improvements in neonatal care, such as use of surfactant to speed lung maturity in very young preterm infants, have resulted in high-risk neonates surviving with less impairment. Indeed, neurologic impairment and respiratory risk, rather than prematurity, predicted negative outcomes in the study by Singer et al (1997).…”

“…There is considerable research reporting the effects of maternal employment on preschool children and limited research on these effects for preschool children with developmental risk, especially for preterm children in single-parent families, where the developmental risk is greater (Singer, Yamashita, Lilien, Collin, & Baley, 1997). In view of changes in the welfare system mandating employment of poor single women, studies on the effects of maternal employment on preterm children are especially important and timely, providing data on which to base public policy and advocate effectively for these children.…”

Long-term sequelae of postnatal surfactant and corticosteroid therapies for BPD

“…17,18 Recruitment strategies for this study have been detailed elsewhere. [17][18][19] A total of 122 infants with BPD were enrolled in this prospective longitudinal study, however 7 died after enrollment. Ninety-eight and 104 children were seen at 3 and 8 years, respectively.…”

“…The validity of the summary score has been demonstrated in previous research. 19 The severity of BPD was determined according to the criteria detailed in the 2001 consensus workshop conducted by NICHD and NHLBI. 2 Four treatment groups were examined based on physician medical management strategy: steroids only, surfactant only, combined steroid and surfactant treatment and neither steroid nor surfactant treatment.…”

Long-Term Follow-up of Premature Infants Treated With Prophylactic, Intratracheal Recombinant Human CuZn Superoxide Dismutase

“…1 The development of BPD is associated with increased mortality and morbidity, such as repeated hospitalizations and neurodevelopmental handicaps. 2 Intraventricular hemorrhage (IVH) and/or periventricular leukomalacia can also develop in 20% to 40% of very low birth weight infants, resulting in long-term neurodevelopmental deficits such as cerebral palsy. 3 Treatment directed at preventing free radical injury may decrease the incidence and severity of these conditions and improve long-term outcome.…”