Document Detail


Changes in neurodevelopmental outcomes at 18 to 22 months' corrected age among infants of less than 25 weeks' gestational age born in 1993-1999.
MedLine Citation:
PMID:  15930228     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Increased survival rates for extremely preterm, extremely low birth weight infants during the postsurfactant era have been reported, but data on changes in neurosensory and developmental impairments are sparse. OBJECTIVE: To compare neuromotor and neurodevelopmental outcomes at 18 to 22 months' corrected age for infants of <25 weeks' estimated gestational age (EGA) who were born in the 1990s. METHODS: This was a multicenter, retrospective, comparative analysis of infants of <25 weeks' EGA, with birth weights of 501 to 1000 g, born between January 1993 and June 1996 (epoch I) or between July 1996 and December 1999 (epoch II), in the National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental assessments were performed at 18 to 22 months' corrected age. Logistic-regression models were constructed to evaluate the independent risk of cerebral palsy, Mental Development Index of <70, Psychomotor Development Index of <70, and neurodevelopmental impairment. RESULTS: A total of 366 patients in epoch I and 473 patients in epoch II were evaluated. Prenatal steroid use, cesarean section, surfactant treatment, bronchopulmonary dysplasia, and severe retinopathy of prematurity were more likely in epoch II, whereas Apgar scores of <5 at 5 minutes, patent ductus arteriosus, and severe intraventricular hemorrhage were more likely in epoch I. The prevalences of cerebral palsy, Psychomotor Development Index of <70, and neurodevelopmental impairment were similar between epochs. The prevalences of Mental Development Index of <70 were 40% for epoch I and 47% for epoch II. Regression analysis revealed that epoch II was an independent risk factor for Mental Developmental Index of <70 (epoch I versus II: odds ratio: 0.63; 95% confidence interval: 0.45-0.87) but not for other outcomes. CONCLUSIONS: Early childhood neurodevelopmental outcomes among infants of <25 weeks' EGA are not improving in the postsurfactant era, despite more aggressive perinatal and neonatal treatment. Later childhood follow-up assessment is needed to delineate trends in severe cognitive impairment in this extremely high-risk group.
Authors:
Susan R Hintz; Douglas E Kendrick; Betty R Vohr; W Kenneth Poole; Rosemary D Higgins;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Pediatrics     Volume:  115     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-06-02     Completed Date:  2005-11-10     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1645-51     Citation Subset:  AIM; IM    
Affiliation:
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304, USA. srhintz@stanford.edu
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MeSH Terms
Descriptor/Qualifier:
Blindness / epidemiology,  etiology,  prevention & control
Brain Damage, Chronic / epidemiology*,  etiology,  prevention & control
Cerebral Palsy / epidemiology,  etiology
Deafness / epidemiology,  etiology,  prevention & control
Female
Fetal Organ Maturity / drug effects
Follow-Up Studies
Gestational Age
Humans
Infant
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / epidemiology*
Infant, Very Low Birth Weight
Lung / drug effects,  embryology
Male
Psychomotor Disorders / epidemiology*,  etiology,  prevention & control
Pulmonary Surfactants / pharmacology,  therapeutic use
Retrospective Studies
Survivors
Treatment Outcome
United States / epidemiology
Grant Support
ID/Acronym/Agency:
U01 HD36790/HD/NICHD NIH HHS; U10 HD21364/HD/NICHD NIH HHS; U10 HD21373/HD/NICHD NIH HHS; U10 HD21385/HD/NICHD NIH HHS; U10 HD21415/HD/NICHD NIH HHS; U10 HD27851/HD/NICHD NIH HHS; U10 HD27853/HD/NICHD NIH HHS; U10 HD27856/HD/NICHD NIH HHS; U10 HD27871/HD/NICHD NIH HHS; U10 HD27880/HD/NICHD NIH HHS; U10 HD27881/HD/NICHD NIH HHS; U10 HD27904/HD/NICHD NIH HHS; U10 HD34167/HD/NICHD NIH HHS; U10 HD34216/HD/NICHD NIH HHS
Chemical
Reg. No./Substance:
0/Pulmonary Surfactants

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