Neuromotor Outcomes in Infants With Bronchopulmonary Dysplasia

Karagianni, Paraskevi; Tsakalidis, Christos; Kyriakidou, Maria; Mitsiakos, Georgıos; Chatziioanidis, Helias; Porpodi, M; Evangeliou, Athanasios; Nikolaides, Nikolaos

doi:10.1016/j.pediatrneurol.2010.07.008

Cited by 23 publications

(17 citation statements)

References 40 publications

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“…Despite the high prevalence of BPD, we were able to extubate 59% of the infants within 10 days, which was comparable to the 60% extubation success rate in infants treated with DXM at starting doses of 0.15 mg/kg [22]. Furthermore, apart from the 2 infants who died of severe BPD, the remaining infants with either mild or moderate BPD all developed normally which is highly exceeding the 30% reported previously [11]. …”

Section: Discussionsupporting

confidence: 62%

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The Quality of General Movements after Treatment with Low-Dose Dexamethasone in Preterm Infants at Risk of Bronchopulmonary Dysplasia

Hitzert

Roescher²,

Bos³

2014

Neonatology

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Background: High-dose dexamethasone (DXM) treatment of preterms at risk of bronchopulmonary dysplasia leads to a deterioration in quality of their general movements (GMs). It is unknown whether low-dose DXM affects GM quality similarly. Objectives: To assess the effect of low-dose DXM treatment on the quality of GMs and fidgety GMs (FMs). Methods: A prospective study of preterms admitted to our NICU between 2010 and 2012, and treated with DXM (starting dose 0.25 mg/kg/day). We assessed GM/FM quality and calculated their motor optimality score (MOS) before, during, and after treatment up to 3 months postterm. Neurological follow-up was performed between 12 and 36 months. We related risk factors with infants' GM trajectories and MOSs. At 3 months we compared the MOSs of low-dose DXM infants and a historical cohort of infants treated with high-dose DXM or hydrocortisone. Results: 17 infants were included. GM/FM quality improved in 9 out of 13 initially abnormal infants (p = 0.004). Shorter periods of mechanical ventilation and higher birth weights were associated with better GM trajectories (p = 0.032 and p = 0.042, respectively). Infants starting treatment later had higher MOSs on day 7 (p = 0.047). Low-dose DXM infants had higher MOSs than high-dose DXM infants (β = -0.535; 95% CI -0.594 to -0.132; p = 0.003). Out of 17 infants, 2 died, 14 developed normally, and 1 developed with mild neurodevelopmental impairments. Infants whose GMs/FMs remained normal or improved had better outcomes than infants whose GMs/FMs remained abnormal (p = 0.019). Conclusions: Out of the 17 infants treated with low-dose DXM, 2 died. Of the surviving infants, neurological functioning improved with the majority having normal neurodevelopment at the age of 12-36 months.

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Section: Discussionsupporting

confidence: 62%

“…We expected around 45% of infants with BPD to develop minor neuromotor disabilities, independent of BPD grading. In infants with mild or moderate BPD, we expected around 20% to develop major neuromotor disabilities with percentages increasing to 45% in infants with severe BPD [11]. …”

Section: Introductionmentioning

confidence: 99%

The Quality of General Movements after Treatment with Low-Dose Dexamethasone in Preterm Infants at Risk of Bronchopulmonary Dysplasia

Hitzert

Roescher²,

Bos³

2014

Neonatology

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“…While attempts have been made to limit the dose and duration of exposure of supplemental oxygen to the immature lungs [29]–[32], given the decreased capacity of the preterm infants to combat oxidative stress, it is not surprising that supplemental oxygen that is required for prolonged periods in this population results in significant medical consequences. The duration of exposure to supplemental oxygen has been associated with delayed head growth [33], and need for supplemental oxygen at 36 weeks PMA has been associated with significant neurodevelopmental delays at 12–24 months CA [34]–[37]. In contrast, a recent study has noted that BPD accompanied by invasive mechanical ventilation at 36 weeks PMA strongly predicted the more common bilateral CP phenotypes (assessed at 2 years), but BPD without invasive mechanical ventilation (i.e.…”

Section: Discussionmentioning

confidence: 97%

Need for Supplemental Oxygen at Discharge in Infants with Bronchopulmonary Dysplasia Is Not Associated with Worse Neurodevelopmental Outcomes at 3 Years Corrected Age

et al. 2014

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ObjectivesTo determine if chronic oxygen dependency (discharge home on supplemental oxygen) in children with bronchopulmonary dysplasia (BPD; defined as requirement for supplemental O2 at 36 weeks postmenstrual age) predicts neurodevelopmental disability rates and growth outcomes at 36 months corrected age (CA).Study DesignLongitudinal cohort study.SettingSouthern Alberta regional center located at high altitude.ParticipantsPreterm infants weighing ≤1250 grams with no BPD, BPD, and BPD with chronic oxygen dependency.Main outcome measuresNeurodevelopmental and growth outcomes.ResultsOf 1563 preterm infants admitted from 1995–2007, 1212 survived. Complete follow-up data were available for 1030 (85%) children. Children in BPD and BPD with chronic oxygen dependency groups had significantly lower birth weights, gestational ages, prolonged mechanical ventilation and oxygen supplementation and received more postnatal steroids, compared to those without BPD. Children with BPD and BPD with chronic oxygen dependency were more likely to be below the 5th centile in weight and height compared to those without BPD but there was little difference between the BPD and BPD with chronic oxygen dependency groups. After controlling for confounding variables, children who had BPD and BPD with chronic oxygen dependency had higher odds of neurodevelopmental disability compared to those without BPD [OR (odds ratio) 1.9 (95%CI 1.1 to 3.5) and OR 1.8 (1.1 to 2.9), respectively], with no significant difference between BPD and BPD with chronic oxygen dependency [OR 0.9 (95% CI 0.6 to 1.5)].ConclusionsBPD and BPD with chronic oxygen dependency in children predicts abnormal neurodevelopmental outcomes at 36 months CA. However, the neurodevelopmental disability rates were not significantly higher in BPD with chronic oxygen dependency children compared to children with BPD only. Compared to those without BPD, growth is impaired in children with BPD and BPD with chronic oxygen dependency, but no difference between the latter two groups.

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“…The incidence of BPD was slightly higher in those with brain abnormalities observed on MRI (41%) compared to those without (37%) but did not correlate with MRI score or the number of signal abnormalities on MRI. Bronchopulmonary dysplasia continues to be one of the main risk factors for motor impairments following preterm birth (Schmidt et al, 2003; Vohr et al, 2005; Karagianni et al, 2011; Schlapbach et al, 2012). …”

Section: Discussionmentioning

confidence: 99%

“…Consequently, abnormal WM development in these regions may be useful for identifying infants with higher risk for adverse outcomes. Known risk factors for poor neurodevelopment following preterm birth include sepsis (Stoll et al, 2002; Schlapbach et al, 2011; Hentges et al, 2013; Mitha et al, 2013), bronchopulmonary dysplasia (Schmidt et al, 2003; Vohr et al, 2005; Karagianni et al, 2011; Schlapbach et al, 2012), necrotizing enterocolitis (NEC) (Hintz et al, 2005; van Vliet et al, 2013), and male sex (Wood et al, 2005; Vohr et al, 2005; Rose et al, 2009; Beaino et al, 2010; Morsing et al, 2011). The aim of this study was to examine the relationship between neonatal physiological risk factors and early brain microstructure in VLBW preterm infants at near-term age, based on qualitative analysis of structural MRI and on semi-automated, atlas-based DTI analysis.…”

Section: Introductionmentioning

confidence: 99%

Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants

Rose

Vassar

Cahill‐Rowley

et al. 2014

NeuroImage: Clinical

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Structural brain abnormalities identified at near-term age have been recognized as potential predictors of neurodevelopment in children born preterm. The aim of this study was to examine the relationship between neonatal physiological risk factors and early brain structure in very-low-birth-weight (VLBW) preterm infants using structural MRI and diffusion tensor imaging (DTI) at near-term age.Structural brain MRI, diffusion-weighted scans, and neonatal physiological risk factors were analyzed in a cross-sectional sample of 102 VLBW preterm infants (BW ≤ 1500 g, gestational age (GA) ≤ 32 weeks), who were admitted to the Lucile Packard Children's Hospital, Stanford NICU and recruited to participate prior to routine near-term brain MRI conducted at 36.6 ± 1.8 weeks postmenstrual age (PMA) from 2010 to 2011; 66/102 also underwent a diffusion-weighted scan. Brain abnormalities were assessed qualitatively on structural MRI, and white matter (WM) microstructure was analyzed quantitatively on DTI in six subcortical regions defined by DiffeoMap neonatal brain atlas. Specific regions of interest included the genu and splenium of the corpus callosum, anterior and posterior limbs of the internal capsule, the thalamus, and the globus pallidus. Regional fractional anisotropy (FA) and mean diffusivity (MD) were calculated using DTI data and examined in relation to neonatal physiological risk factors including gestational age (GA), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), and sepsis, as well as serum levels of C-reactive protein (CRP), glucose, albumin, and total bilirubin.Brain abnormalities were observed on structural MRI in 38/102 infants including 35% of females and 40% of males. Infants with brain abnormalities observed on MRI had higher incidence of BPD (42% vs. 25%) and sepsis (21% vs. 6%) and higher mean and peak serum CRP levels, respectively, (0.64 vs. 0.34 mg/dL, p = .008; 1.57 vs. 0.67 mg/dL, p= .006) compared to those without. The number of signal abnormalities observed on structural MRI correlated to mean and peak CRP (rho = .316, p = .002; rho = .318, p= .002). The number of signal abnormalities observed on MRI correlated with thalamus MD (left: r= .382, p= .002; right: r= .400, p= .001), controlling for PMA-at-scan. Thalamus WM microstructure demonstrated the strongest associations with neonatal risk factors. Higher thalamus MD on the left and right, respectively, was associated with lower GA (r = −.322, p = .009; r= −.381, p= .002), lower mean albumin (r = −.276, p= .029; r= −.385, p= .002), and lower mean bilirubin (r = −.293, p= .020; r= −.337 p= .007).Results suggest that at near-term age, thalamus WM microstructure may be particularly vulnerable to certain neonatal risk factors. Interactions between albumin, bilirubin, phototherapy, and brain development warrant further investigation. Identification of physiological risk factors associated with selective vulnerability of certain brain regions at near-term age may clarify the etiology of neurodevelopm...

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Neuromotor Outcomes in Infants With Bronchopulmonary Dysplasia

Cited by 23 publications

References 40 publications

The Quality of General Movements after Treatment with Low-Dose Dexamethasone in Preterm Infants at Risk of Bronchopulmonary Dysplasia

The Quality of General Movements after Treatment with Low-Dose Dexamethasone in Preterm Infants at Risk of Bronchopulmonary Dysplasia

Need for Supplemental Oxygen at Discharge in Infants with Bronchopulmonary Dysplasia Is Not Associated with Worse Neurodevelopmental Outcomes at 3 Years Corrected Age

Neonatal physiological correlates of near-term brain development on MRI and DTI in very-low-birth-weight preterm infants

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