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Increased risk of cerebral palsy among very low-birthweight infants with chronic lung disease
M D Skidmore1, A Rivers, M Hack
1Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
Insights
Very low-birthweight infants with severe chronic lung disease (CLD) face higher risks of cerebral palsy and neurosensory impairments. Early identification and management of CLD are crucial for improving outcomes in high-risk neonates.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Respiratory Medicine
Background:
- Very low-birthweight infants are susceptible to respiratory complications.
- Chronic lung disease (CLD) is a significant concern in premature infants.
- Neurodevelopmental outcomes in high-risk neonates require thorough investigation.
Purpose of the Study:
- To assess the risk of cerebral palsy and neurosensory impairment in very low-birthweight infants with severe lung disease.
- To compare these risks with infants exhibiting lesser degrees of lung disease.
- To identify perinatal and demographic factors associated with CLD.
Main Methods:
- Prospective follow-up of 249 very low-birthweight infant survivors born between 1983 and 1984.
- Definition of CLD as oxygen dependence for >= 28 days.
- Assessment of neurological and neurosensory impairments.
Main Results:
- 21% of infants developed CLD.
- 15% of infants with CLD developed cerebral palsy, versus 3-4% with less severe lung disease.
- Overall neurological impairment rate was 29% for infants with CLD, compared to 6-9% for others.
- Infants with CLD had lower birthweight, gestational age, higher rates of intraventricular hemorrhage, and longer hospital stays.
Conclusions:
- Severe chronic lung disease in very low-birthweight infants is associated with a substantially increased risk of cerebral palsy and broader neurosensory impairments.
- Lower birthweight, earlier gestational age, and intraventricular hemorrhage are linked to CLD.
- These findings underscore the importance of addressing lung disease in neonatal intensive care to mitigate long-term neurodevelopmental deficits.
Abstract:
To determine the risk of cerebral palsy and other forms of neurosensory impairment in very low-birthweight infants (less than 1500g) with severe lung disease, as compared with those with lesser degrees of lung disease, and to examine perinatal and demographic correlates of chronic lung disease, the authors prospectively followed 249 survivors born between 1983 and 1984. 52 (21 per cent) developed chronic lung disease (CLD), defined as oxygen dependence greater than or equal to 28 days. 15 per cent of children with CLD developed cerebral palsy, compared with 3 per cent who required oxygen for between three and 27 days and 4 per cent of those requiring oxygen for two days or less. The overall neurological impairment rate, including cerebral palsy, abnormalities of muscle tone, hydrocephalus requiring a shunt, and severe visual or hearing impairment, was 29 per cent for infants with CLD. This compares with rates of 9 per cent for those requiring oxygen for between three and 27 days and 6 per cent for those on oxygen for two or less days. Infants with CLD had a significantly lower mean birthweight and gestational age; 43 per cent had grade III or IV intraventricular hemorrhages; and they also required longer periods in hospital.