Effect of severe neonatal morbidities on long term outcome in extremely low birthweight infants

Abstract

PurposeTo assess the validity of individual and combined prognostic effects of severe bronchopulmonary dysplasia (BPD), brain injury, retinopathy of prematurity (ROP), and parenteral nutrition associated cholestasis (PNAC).MethodsWe retrospectively analyzed the medical records of 80 extremely low birthweight (ELBW) infants admitted to the neonatal intensive care unit (NICU) of the Severance Children's Hospital, and who survived to a postmenstrual age of 36 weeks. We analyzed the relationship between 4 neonatal morbidities (severe BPD, severe brain injury, severe ROP, and severe PNAC) and poor outcome. Poor outcome indicated death after a postmenstrual age of 36 weeks or survival with neurosensory impairment (cerebral palsy, delayed development, hearing loss, or blindness) between 18 and 24 months of corrected age.ResultsEach neonatal morbidity correlated with poor outcome on univariate analysis. Multiple logistic regression analysis revealed that the odds ratios (OR) were 4.9 (95% confidence interval [CI], 1.0-22.6; P=0.044) for severe BPD, 13.2 (3.0-57.3; P<.001) for severe brain injury, 5.3 (1.6-18.1; P=0.007) for severe ROP, and 3.4 (0.5-22.7; P=0.215) for severe PNAC. Severe BPD, brain injury, and ROP were significantly correlated with poor outcome, but not severe PNAC. By increasing the morbidity count, the rate of poor outcome was significantly increased (OR 5.2; 95% CI, 2.2-11.9; P<.001). In infants free of the above-mentioned morbidities, the rate of poor outcome was 9%, while the corresponding rates in infants with 1, 2, and more than 3 neonatal morbidities were 46%, 69%, and 100%, respectively.ConclusionIn ELBW infants 3 common neonatal mornidifies, severe BPD, brain injury and ROP, strongly predicts the risk of poor outcome.

Definition and Outpatient Management of the Very Low-Birth-Weight Infant With Bronchopulmonary Dysplasia

“…Infants and young children with BPD are at increased risk of rehospitalization and numerous complications during home management (Table 4) [1,30]. The risk of poor outcomes, including death, in VLBW/ELBW infants is greatest for those with severe BPD, brain injury, and severe ROP [39]. The incidence of medically related problems is usually greatest during the first 2 years after discharge but can persist beyond very early childhood [40].…”

Model that predicted death or disabilities in premature infants was valid at seven years of age

“… concluded that the diagnosis of any one, two or three morbidities in the neonatal period were able to predict late death or disability at the age of five. This model was applied using a small Korean cohort of extremely premature infants and produced similar results. Our results only demonstrated that having two morbidities could predict death or disability at the age of seven.…”

Nutritional problems of children with bronchopulmonary dysplasia after hospital discharge

“…BPD patients show higher mortality risk, 18 obstructive respiratory symptoms and frequent airway infections (especially caused by respiratory syncytial virus), often until the age of 8. 19 They also have lower cognitive abilities and performances at school; 20 they suffer from reduced motor skills gastroesophageal reflux disease, 21 hearing loss and ROP.…”