Bronchopulmonary dysplasia and neurobehavioural outcomes at birth and 2 years in infants born before 30 weeks

Abstract

ObjectiveTo identify neurobehavioural risks in preterm infants with bronchopulmonary dysplasia (BPD) prior to hospital discharge.Design and patientsLongitudinal study of 676 newborns born before 30 weeks of gestation.SettingNine university NICUs affiliated with six universities. All were Vermont Oxford Network (VON) participants.Patients and interventionsInfants were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study from April 2014 to June 2016. Prospective medical record reviews, VON definitions and criteria, and maternal interviews were used to collect maternal and neonatal medical variables and socioenvironmental data.Main Outcome MeasuresNICU Network Neurobehavioral Scale (NNNS) at the time of hospital discharge; Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) and Gross Motor Function Classification System at 2 years’ corrected age.ResultsInfants with moderate/severe BPD were less attentive (Wald χ2 9.68, p=0.008), more lethargic (Wald χ2 9.91, p=0.007), with increased non-optimal reflexes (Wald χ2 7.37, p=0.025). Infants with moderate/severe BPD were more likely to have Bayley-III language and motor scores <85 (adjusted OR (aOR) 1.74, 95% CI 1.06 to 2.85, and aOR 2.06, 95% CI 1.10 to 3.85). Infants with both moderate/severe and mild BPD were more likely to have a cerebral palsy diagnosis (aOR 2.96, 95% CI 1.34 to 6.54, and aOR 2.81, 95% CI 1.32 to 5.99).ConclusionsBPD severity presents risks for poor neurodevelopment at NICU discharge and at age 2 years. Early identification of poorly regulated behaviour can provide critical information for early preventive and targeted interventions with potential to improve long-term outcomes.

Corpus callosum abnormalities at term-equivalent age are associated with language development at two years corrected age in infants born very preterm

“…Alongside microstructural white matter abnormalities, other factors such as social risk score, female sex, and severe brain abnormalities identified on brain MRI at term-corrected age were significantly associated with language outcomes, aligning with previous research 25, 26 . In contrast, severe BPD 41 and late-onset sepsis 42 - factors previously found to significantly predict language outcomes - did not exhibit a statistically significant association with language outcomes in our model. This discrepancy might be attributed to the relatively low occurrence of these events in our study (Of the participants who had neurodevelopmental data, 12 (4%) had severe BPD, and 31 (11%) had sepsis.…”

Postnatal corticosteroids and developmental outcomes in extremely preterm or extremely low birth weight infants: The Victorian Infant Collaborative Study 2016–17 cohort

“…BPD, usually defined as the need for supplemental oxygen or respiratory support at 36 weeks' postmenstrual age, 3 is a chronic lung disease that affects more than 50% of surviving EP infants 1 . BPD is independently associated with higher mortality, increased incidence of cerebral palsy (CP) and higher rates of cognitive impairment 4–7 …”

“…1 BPD is independently associated with higher mortality, increased incidence of cerebral palsy (CP) and higher rates of cognitive impairment. [4][5][6][7] Postnatal systemic corticosteroids are used to treat or prevent BPD in EP infants. 8 Corticosteroids facilitate weaning from mechanical ventilation.…”

Neurodevelopment and healthcare utilisation at age 5–6 years in bronchopulmonary dysplasia: an EPIPAGE-2 cohort study

“…Among other factors, the survival of children with lower gestational age,3 increased non-invasive support4 and new ventilation devices may have changed the consequences of BPD. Furthermore, in many recent studies,5 6 whose recruitment took place in the 2010s, neurodevelopmental follow-up of children with BPD ended at age 18–24 months, when developmental assessment is still incomplete, and most of the studies focused on motor7 and cognitive disabilities 1. No recent study has analysed the association of BPD with behavioural difficulties or social interaction disorders after age 2 years.…”