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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Effect of severe neonatal morbidities on long term outcome in extremely low birthweight infants
Kyo Yeon Koo1, Jeong Eun Kim, Soon Min Lee
1Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea.
Insights
Severe bronchopulmonary dysplasia, brain injury, and retinopathy of prematurity in extremely low birthweight infants are strong predictors of poor outcomes. Combined morbidities significantly increase the risk of adverse neurosensory impairment or death.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Critical Care Pediatrics
Background:
- Extremely low birthweight (ELBW) infants face significant risks of multiple neonatal morbidities.
- Assessing the prognostic impact of these morbidities is crucial for predicting long-term outcomes.
Purpose of the Study:
- To evaluate the individual and combined prognostic significance of severe bronchopulmonary dysplasia (BPD), brain injury, retinopathy of prematurity (ROP), and parenteral nutrition-associated cholestasis (PNAC) in ELBW infants.
- To determine the association between these morbidities and poor outcomes, including death or neurosensory impairment.
Main Methods:
- Retrospective analysis of medical records for 80 ELBW infants surviving to 36 weeks postmenstrual age.
- Investigated the relationship between four specific neonatal morbidities and poor outcomes.
- Poor outcome defined as death after 36 weeks or neurosensory impairment at 18-24 months corrected age.
Main Results:
- Severe BPD, brain injury, and ROP were significantly correlated with poor outcomes (ORs 4.9, 13.2, and 5.3, respectively).
- Severe PNAC did not show a significant correlation with poor outcome (OR 3.4).
- A higher count of morbidities significantly increased the rate of poor outcome (OR 5.2), with rates reaching 100% in infants with more than three morbidities.
Conclusions:
- Severe BPD, brain injury, and ROP are strong predictors of poor outcomes in ELBW infants.
- The cumulative effect of these morbidities substantially elevates the risk of adverse long-term results.
- PNAC may not be a primary independent predictor of poor outcome in this cohort.
Purpose:
To 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).
Methods:
We 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.
Results:
Each 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.
Conclusion:
In ELBW infants 3 common neonatal mornidifies, severe BPD, brain injury and ROP, strongly predicts the risk of poor outcome.
