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Prevalence and aetiology of neurological impairment in extremely low birthweight infants
J Waugh1, M J O'Callaghan, D I Tudehope
1Department of Neonatology and Growth and Development Clinic, Mater Misericordiae Public Hospitals, South Brisbane, Queensland, Australia.
Insights
Extremely low birthweight infants face risks of cerebral palsy and intellectual impairment, with ventricular dilatation being a key predictor. Male sex and vaginal delivery also increased intellectual impairment risk in this cohort.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Neuroscience
Background:
- Extremely low birthweight (ELBW) infants represent a vulnerable population with increased risks of neurodevelopmental impairments.
- Understanding the prevalence and predictors of these impairments is crucial for early intervention and improved outcomes.
Purpose of the Study:
- To determine the prevalence of cerebral palsy, intellectual impairment, visual impairment, and deafness in ELBW infants at two years of age.
- To identify perinatal predictors associated with these neurodevelopmental outcomes.
Main Methods:
- A cohort of 199 extremely low birthweight infants surviving to two years was assessed.
- Clinical, psychometric, and audiological evaluations were used to measure outcomes.
- Twenty-four potential risk factors were examined for their association with adverse outcomes.
Main Results:
- Cerebral palsy occurred in 10% of infants, with ventricular dilatation being a significant predictor.
- Intellectual impairment affected 10% of infants, associated with ventricular dilatation, high oxygen ventilation, vaginal delivery, and male sex.
- Retinopathy of prematurity was linked to visual impairment; no perinatal predictors for deafness were identified.
Conclusions:
- Intellectual impairment in ELBW infants is associated with multiple perinatal factors.
- Cerebral palsy shares some predictors with intellectual impairment, suggesting overlapping pathways of neurological injury.
- Male sex and multiple birth may indicate susceptibility to neurological injury rather than being direct causes.
Objective:
To determine the prevalence and perinatal predictors of cerebral palsy, intellectual impairment, visual impairment and deafness in a cohort of extremely low birthweight (ELBW) infants at two years of age.
Methodology:
The study population comprised 199 of the 224 (89%) ELBW infants managed at the Mater's Mothers Hospital, Brisbane, between July 1977 and February 1990 and who survived to two years. The prevalence of cerebral palsy, intellectual impairment, blindness and deafness was measured by clinical,psychometric and audiological assessment and the association with 24 risk factors examined.
Results:
Cerebral palsy occurred in 20 children (10%). Risk of cerebral palsy was associated with ventricular dilatation, intraventricular haemorrhage, necrotizing enterocolitis and multiple birth, though only ventricular dilatation (OR 4.41; 95% CI 1.32-14.8) remained significant in the adjusted analysis. Intellectual impairment occurred in 20 children (10%) and was independently associated with ventricular dilatation (OR 15.0; 95% CI 2.2-102.8), ventilation F(i)(2) > 80% (OR 3.4; 95% CI 1.01-11.5), vaginal delivery (OR 3.5; 95% Cl 1.09-11.4) and male sex (OR 6.1; 95% Cl 1.67-22.3). No perinatal predictor was statistically associated with risk of deafness. Retinopathy of prematurity (OR 36.9; 95% Cl 2.8-495.5) was associated with risk of later visual impairment.
Conclusions:
Intellectual impairment was associated with a broad range of perinatal variables. Cerebral palsy was associated with fewer variables, all of which were also associated with intellectual impairment. Neurologic injury was associated with male sex and multiple birth, which are not biological insults themselves, but may be markers of susceptibility to injury.