Developmental Sequelae in Preterm Infants Having a Diagnosis of Bronchopulmonary Dysplasia

Abstract

Objective: To investigate the relationship between the severity-based definition of bronchopulmonary dysplasia (BPD), choice of treatment, and neurocognitive outcomes at age 3 and 8 years.Design: This is a secondary analysis of data collected from a prospective, longitudinal sample of 99 children with a history of BPD.Setting: Children born with BPD admitted to 3 hospitals from February 1, 1989, to November 31, 1991.Participants: Ninety-nine children with BPD were longitudinallyassessedatage3and8years.Threeseveritygroups (mild, moderate, and severe) were formed based on gestational age and need for supplemental oxygen therapy.Main Exposures: Supplemental oxygen therapy for 28 days or longer, birth weight less than 1500 g, and radiographic evidence of lung disease.Main Outcome Measures: Neurologic and medical outcomes; type of medical management; and language, achievement, and cognitive functioning were compared among the 3 severity groups.Results: Severity classification of BPD was associated with poorer outcomes. Compared with children with mild or moderate BPD, children with severe BPD performed more poorly on IQ tests (Mental Development Index, 90 vs 76.4; and Psychomotor Development Index, 92.5 vs 73.9) and language measures (total, 95 vs 82) at age 3 years and performance IQ (86 vs 75) and perceptual organization (86 vs 76) at age 8 years. Severity of BPD was not associated with choice of medical management but was related to educational interventions. Children with severe BPD received more special education services (69% vs 44%) than did children with mild BPD. Conclusions:The severity-based classification clarifies the relationship between BPD and developmental sequelae. Children with severe BPD required more interventions at age 8 years than did children with mild or moderate BPD.

Neonatal respiratory dysfunction and neuropsychological performance at the preschool age: A study of very preterm infants with bronchopulmonary dysplasia.

“…Our findings differ from those of Short et al's (2007) reanalysis of their 2003 data. The Cleveland group found neurocognitive outcome differences in multiple functional domains between BPD subgroups, classified according to the NICHD/NHLBI Workshop criteria.…”

Neonatal respiratory dysfunction and neuropsychological performance at the preschool age: A study of very preterm infants with bronchopulmonary dysplasia.

“…Our findings differ from those of Short et al's (2007) reanalysis of their 2003 data. The Cleveland group found neurocognitive outcome differences in multiple functional domains between BPD subgroups, classified according to the NICHD/NHLBI Workshop criteria.…”

Growth mixture modeling of academic achievement in children of varying birth weight risk.

“…Among the children with VLBW, risk factors that marked a more complicated neonatal course, including more days on ventilation, a longer period of neonatal hospitalization, and chronic lung disease predicted class membership for one of more of the achievement outcomes. Although consistent with previous findings (D 'Angio et al, 2002;Short et al, 2007;Taylor, 1998Taylor, , 2006, these results extend this literature by indicating that these associations are independent of BWT. Calculation was the most sensitive to disruption among the two mathematics domains, as the probability of classification as lowcompared to average-achieving for Calculation was higher than that for Problem-Solving at the fewer days of ventilation (34 days compared to 43 days with BWT controlled).…”

Early Macrophage Activation in Preterm Newborns and Respiratory Disease

“…17,18 In addition, also cytokines profile is different, characterized by a deficit of pro-inflammatory IL-1 or Il-6 and TNF-α production, 19,20 with a prevalence of anti-inflammatory IL-10 and TGF-β. 21,22 Our results are in line with the hypothesis that preterm newborns are defective in macrophage function and activation, related to impaired cytokines production. 19 Furthermore, the association we found between more preterm delivery and higher level of M2 agrees with recent studies that compared term and preterm macrophages activation status.…”

Neonatal respiratory dysfunction and neuropsychological performance at the preschool age: A study of very preterm infants with bronchopulmonary dysplasia.

“…Our findings differ from those of Short et al's (2007) reanalysis of their 2003 data. The Cleveland group found neurocognitive outcome differences in multiple functional domains between BPD subgroups, classified according to the NICHD/NHLBI Workshop criteria.…”

Growth mixture modeling of academic achievement in children of varying birth weight risk.

“…Among the children with VLBW, risk factors that marked a more complicated neonatal course, including more days on ventilation, a longer period of neonatal hospitalization, and chronic lung disease predicted class membership for one of more of the achievement outcomes. Although consistent with previous findings (D 'Angio et al, 2002;Short et al, 2007;Taylor, 1998Taylor, , 2006, these results extend this literature by indicating that these associations are independent of BWT. Calculation was the most sensitive to disruption among the two mathematics domains, as the probability of classification as lowcompared to average-achieving for Calculation was higher than that for Problem-Solving at the fewer days of ventilation (34 days compared to 43 days with BWT controlled).…”

Early Macrophage Activation in Preterm Newborns and Respiratory Disease

“…17,18 In addition, also cytokines profile is different, characterized by a deficit of pro-inflammatory IL-1 or Il-6 and TNF-α production, 19,20 with a prevalence of anti-inflammatory IL-10 and TGF-β. 21,22 Our results are in line with the hypothesis that preterm newborns are defective in macrophage function and activation, related to impaired cytokines production. 19 Furthermore, the association we found between more preterm delivery and higher level of M2 agrees with recent studies that compared term and preterm macrophages activation status.…”

Neonatal respiratory dysfunction and neuropsychological performance at the preschool age: A study of very preterm infants with bronchopulmonary dysplasia.

“…Our findings differ from those of Short et al's (2007) reanalysis of their 2003 data. The Cleveland group found neurocognitive outcome differences in multiple functional domains between BPD subgroups, classified according to the NICHD/NHLBI Workshop criteria.…”

Growth mixture modeling of academic achievement in children of varying birth weight risk.

“…Among the children with VLBW, risk factors that marked a more complicated neonatal course, including more days on ventilation, a longer period of neonatal hospitalization, and chronic lung disease predicted class membership for one of more of the achievement outcomes. Although consistent with previous findings (D 'Angio et al, 2002;Short et al, 2007;Taylor, 1998Taylor, , 2006, these results extend this literature by indicating that these associations are independent of BWT. Calculation was the most sensitive to disruption among the two mathematics domains, as the probability of classification as lowcompared to average-achieving for Calculation was higher than that for Problem-Solving at the fewer days of ventilation (34 days compared to 43 days with BWT controlled).…”

Early Macrophage Activation in Preterm Newborns and Respiratory Disease

“…17,18 In addition, also cytokines profile is different, characterized by a deficit of pro-inflammatory IL-1 or Il-6 and TNF-α production, 19,20 with a prevalence of anti-inflammatory IL-10 and TGF-β. 21,22 Our results are in line with the hypothesis that preterm newborns are defective in macrophage function and activation, related to impaired cytokines production. 19 Furthermore, the association we found between more preterm delivery and higher level of M2 agrees with recent studies that compared term and preterm macrophages activation status.…”