Cognitive and Academic Consequences of Bronchopulmonary Dysplasia and Very Low Birth Weight: 8-Year-Old Outcomes

Abstract

ABSTRACT. Objective. To examine the effects of bronchopulmonary dysplasia (BPD) and very low birth weight (VLBW) on the cognitive and academic achievement of a large sample of 8-year-old children.Methods. Infants who were VLBW and had BPD (n ‫؍‬ 98) or did not have BPD (n ‫؍‬ 75) and term infants (n ‫؍‬ 99) were followed prospectively to age 8. Groups were compared on measures assessing 4 broad areas of functioning: intelligence, achievement, gross motor, and attentional skills. Measures included the Wechsler Intelligence Scale for Children III, the Woodcock Johnson Test of Achievement-Revised, the Bruininks-Oseretsky Test of Motor Proficiency, the Tactual Performance Test (spatial memory), and the Continuous Performance Test (attention). School outcomes were assessed by parent and teacher report, as well as from school records. Groups were comparable on socioeconomic status, sex, and race. The total sample of BPD, VLBW, and term children was compared on all outcome measures. In addition, neurologic risk was assessed in the present sample and included the following: intraventricular hemorrhage, echodense lesions, porencephaly, hydrocephalus, ventriculoperitoneal shunt, meningitis, and periventricular leukomalacia. Individual difference analyses were conducted for neurologically intact children in all 3 groups. Finally, treatment effects were examined by comparing BPD children who had received steroids as part of their treatment with BPD children who had not.Results. The BPD group demonstrated deficits compared with VLBW and term children in intelligence; reading, mathematics, and gross motor skills; and special education services. VLBW children differed from term children in all of the above areas, except reading recognition, comprehension, and occupational therapy. Attentional differences were obtained between BPD and term children only. The BPD group (54%) was more likely to be enrolled in special education classes than VLBW (37%) or term children (25%). In addition, more BPD children (20%) achieved full-scale IQ scores <70, in the mental retardation range, compared with either VLBW (11%) or term (3%) children, with all VLBW children significantly more likely than term children to achieve IQs in the subaverage category. After controlling for birth weight and neurologic problems, BPD and/or duration on oxygen predicted lower performance IQ, perceptual organization, full-scale IQ, motor and attentional skills, and special education placement. The qualitative classification of BPD (present or absent) was a significant predictor for lower scores on measures of applied problems; motor skills; and incidence of speech-language, occupational, and physical therapies. Individual difference analyses were performed to ascertain whether differences between the risk groups were primarily attributable to neurologic complications. Even with the neurologically intact sample of BPD and VLBW children, differences between the term comparison group and both the BPD and VLBW groups were found for many outcome measures. When birth w...

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

“…In our previous work with this sample, 17 we demonstrated that steroid use was associated with poorer neurodevelopmental outcomes in the BPD group as a whole; however outcome differences within the BPD group as a function of surfactant treatment were not examined nor were direct comparisons made between children receiving different management strategies. Examining the long-term effects of several treatment options in a BPD cohort that varied in terms of disease severity will help generate hypotheses about how treatment procedures selected to manage BPD are associated with risk factors.…”

“…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.…”

Early diagnosis of abnormal development of preterm newborns: assessment instruments

“…A melhora no suporte assistencial oferecido às gestantes e a grande evolução tecnológica nos suportes utilizados nas unidades de terapia intensiva (UTI) neonatais aumentaram as possibilidades de sobrevida desses bebês 1,2 . Em pré-termos, as comorbidades associadas, tais como necessidade de suporte ventilatório por perí-odos prolongados, displasia broncopulmonar, hemorragia intracraniana e icterícia, somam-se e contribuem para aumentar os riscos de prejuízos para o desenvolvimento [3][4][5] .…”

Diagnóstico precoce de anormalidades no desenvolvimento em prematuros: instrumentos de avaliação

“…1,2 Preterm newborns present with several associated comorbidities such as long-term ventilatory support, bronchopulmonary dysplasia, cerebral hemorrhage and jaundice that contribute to increase the risk of developmental impairments. [3][4][5] The direct and indirect consequences related to prematurity can cause damages that impair the child's future development. 2 Approximately 30% of the preterm children develop severe motor impairments and are often diagnosed with cerebral palsy.…”

“…Preterm children at low risk for developmental deficits have shown difficulties related to other developmental areas besides the motor area. 5,[8][9][10][11] Studies involving preterm children at school age have found a higher incidence of learning disorders, attention deficits, hyperactivity and behavioral problems in this population. [12][13][14] These future impairments can be reduced with early intervention.…”