Neurodevelopment and Predictors of Outcomes of Children With Birth Weights of Less Than 1000 g

Abstract

Objective: To examine the neurosensory and cognitive status of extremely low-birth-weight (ELBW; Ͻ1000 g) children born from January 1, 1992, through December 31, 1995, and to identify the significant predictors of outcome.Design: An inception cohort of ELBW infants admitted to the neonatal intensive care unit (NICU) and observed to 20 months' corrected age.Setting: A tertiary level urban NICU and follow-up clinic at a university hospital.Population: Of 333 ELBW infants without major congenital malformations admitted to the NICU, 241 (72%) survived to 20 months' corrected age. We studied 221 children (92%) at a mean of 20 months' corrected age. The mean birth weight was 813 g; mean gestational age, 26.4 weeks.Main Outcome Measures: Assessments of cognitive and neurosensory development.Results: Major neurosensory abnormality was present in 54 children (24%), including 33 (15%) with cerebral palsy, 20 (9%) with deafness, and 2 (1%) with blindness. The mean (± SD) Bayley Mental Developmental Index (MDI) score was 74.7 ± 17. Ninety-two children (42%) had a subnormal MDI score (Ͻ70). Neurodevelopmental impairment (neurosensory abnormality and/or MDI score Ͻ70) was present in 105 children (48%). Multiple stepwise logistic regression analysis that considered sex, social risk, birth weight, and neonatal risk factors revealed significant predictors of a subnormal MDI score to be male sex (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.52-4.92), social risk (OR, 1.48; 95% CI, 1.09-2.00), and chronic lung disease (OR, 2.18; 95% CI, 1.20-3.94). Predictors of neurologic abnormality were a severely abnormal finding on cerebral ultrasound (OR, 8.09; 95% CI,) and chronic lung disease (OR, 2.46; 95% CI, 1.12-5.40); predictors of deafness were male sex (OR, 2.79; 95% CI, 1.02-7.62), sepsis (OR, 3.15; 95% CI, 1.05-9.48), and jaundice (maximal bilirubin level, Ͼ171 µmol/L [Ͼ10 mg/dL]) (OR, 4.80; 95% CI, 1.46-15.73). Conclusion:There is an urgent need for research into the etiology and prevention of neonatal morbidity. Med. 2000;154:725-731 Arch Pediatr Adolesc

Desenvolvimento cognitivo e linguagem em prematuros

“…The literature suggests that preterm newborns are more prone to exhibit development delays in motor, language, and cognitive areas (17)(18)(19)(20) . In the study analyzed, we observed that the chronological and corrected age could influence the development of these areas.…”

Pattern of daily weights among low birth weight neonates in the neonatal intensive care unit: data from a multihospital health-care system

“…It is clear that the risk of neurodevelopmental handicap is inversely related to birth weight. 21,22 It is also clear that undernutrition in early infancy can be a cause of neurodevelopmental delay. 6,22 On that basis it is tempting to speculate that divergence in the growth lines is due, at least in part, to progressive undernutrition of the lowest birth weight cohorts.…”

“…21,22 It is also clear that undernutrition in early infancy can be a cause of neurodevelopmental delay. 6,22 On that basis it is tempting to speculate that divergence in the growth lines is due, at least in part, to progressive undernutrition of the lowest birth weight cohorts. If, consistent with the work of Adamkin, 6 Cooke, 23 Cooke et al, 24 Clark et al, 25 and Clark 26 this divergence is indeed the result of suboptimal nutrition of ELBW neonates during this period, the recognition of such provides an opportunity to remedy the situation, by focusing additional efforts on nutrition during this critical time in development.…”

The development of potentially better practices to support the neurodevelopment of infants in the NICU

“…435,[437][438][439][440][441][442][443][444][445] Of these infants, only 3 to 5% are diagnosed with classic cystic periventricular leucomalacia. 446 Follow-up studies of premature infants demonstrate that there are many infants without ultrasound evidence of abnormality who continue to demonstrate significant cognitive and behavioral deficits.…”