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Neurodevelopmental outcome of extremely low birth weight infants in Maryland
R K Blitz1, R C Wachtel, L Blackmon
1Developmental Pediatric Associates, Scottsdale, Arizona, USA.
Insights
Extremely low birth weight (ELBW) infants show improved survival but many experience developmental delays. Bronchopulmonary dysplasia and periventricular leukomalacia are key risk factors, highlighting the need for early intervention services.
Area of Science:
- Neonatology
- Developmental Pediatrics
- Perinatal Medicine
Background:
- Survival rates for extremely low birth weight (ELBW) infants have improved due to advances in neonatology.
- Existing studies on neurodevelopmental outcomes of ELBW survivors often require long follow-up periods.
- Early identification and intervention for developmental issues in ELBW infants remain critical.
Purpose of the Study:
- To assess the one-year corrected age outcomes of 100 ELBW infants born in 1990.
- To identify factors contributing to neurodevelopmental outcomes in this cohort.
- To evaluate the recognition and management of developmental problems in ELBW survivors.
Main Methods:
- Retrospective analysis of 100 ELBW infants born in Maryland in 1990.
- Assessment of neurodevelopmental status at one year corrected age, including cognitive, motor, and language abilities.
- Analysis of the association between neonatal events (e.g., BPD, PVL, surfactant use) and developmental outcomes.
Main Results:
- 72% of ELBW infants had no severe disability, but 51% showed abnormal neurological exams, and 24% had cerebral palsy (CP).
- Significant percentages exhibited below-average cognitive (18%), motor (30%), and language (33%) abilities.
- Bronchopulmonary dysplasia (BPD) and periventricular leukomalacia (PVL) were major predictors of developmental outcomes; rescue surfactant use was linked to higher BPD rates.
Conclusions:
- ELBW infants are at high risk for significant developmental problems, even without severe disabilities.
- Many developmental issues in ELBW survivors are unrecognized by primary physicians and lack appropriate early intervention services (EIS).
- Targeted outreach, developmental monitoring, EIS, and parent support are essential for improving outcomes in ELBW infants.
Abstract:
The survival rate of extremely low birth weight (ELBW; i.e. < 1001 grams) infants has significantly improved in the past 10 years secondary to the numerous advances in neonatology. There have been many favorable reports of the neurodevelopmental outcomes of survivors, but the studies often span several years to collect sufficient number of subjects. This study assesses the outcome of 100 ELBW infants born in Maryland in 1990 and analyzes factors that may have contributed to their outcomes at one year corrected age. Of this group, 72% had no evidence of severe disability (e.g., cerebral palsy (CP) or mental retardation (MR); however, 51% of the children had abnormal or suspect neurological examinations, and 24% had CP. Eighteen percent of the children were more than one standard deviation below the mean cognitively; 30% were below normal for motor abilities, and 33% were below normal for language abilities. Prior to this study, many of these children were not recognized by their primary physician as having any developmental problems. Many of these children were not followed in neonatal intensive care unit (NICU) follow-up programs, and most were not receiving appropriate early intervention services (EIS). Previous studies have associated different neonatal events with the risk of developmental delay. Bronchopulmonary dysplasia (BPD) and periventricular leukomalacia (PVL) accounted for most of the variance of this sample's developmental outcome. Of these 100 ELBW infants, 56 received surfactant. Analysis demonstrated no significant differences in developmental outcomes between those who received surfactant and those who did not. However, those who received rescue surfactant were more likely to acquire a diagnosis of BPD. As demonstrated by this study, ELBW infants are at risk for significant developmental problems. This supports the need for targeted outreach, developmental monitoring, early intervention services, and parent support and education.