title: Multivariate risks among extremely premature infants.
abstract: This study was designed to identify risk factors for mortality and morbidity of extremely premature infants born in the surfactant era. The study cohort included 194 infants born at < 29 weeks' gestation at one regional tertiary center between 1983 and 1986. Forty-one infants died. Blinded neurodevelopmental assessments were performed on 149 of 153 (97%) survivors at a mean age of 52 months. Thirty-one (21%) survivors had major impairments: 15 had mental retardation, 8 had multiple impairments, 7 had cerebral palsy, and 1 was blind. Logistic regression analysis identifies five significant risk factors for mortality: grade III or IV intraventricular hemorrhage, birth weight < 800 gm, 5-minute Apgar score < or = 3, male sex, and absence of surfactant therapy. Significant risk factors for any major impairment included sepsis (relative risks [RR] = 6.4), male sex (RR = 3.1), and nonwhite race (RR = 2.8). Hydrocephalus requiring shunting was a significant risk factor for cerebral palsy (RR = 16.4) and neonatal retardation (RR = 16.0). Nonwhite race (RR = 7.3), sepsis (RR = 6.8), and male sex (RR = 3.7) also were significant risk factors for mental retardation. Confirmation of these risk factors should facilitate development of targeted interventions for optimizing long-term outcome.
authors.affiliation: Department of Pediatrics, Robert Warner Rehabilitation Center, Buffalo, NY 14209.
authors.forename: M E
authors.initials: ME
authors.lastname: Msall
authors.forename: G M
authors.initials: GM
authors.lastname: Buck
authors.forename: B T
authors.initials: BT
authors.lastname: Rogers
authors.forename: D P
authors.initials: DP
authors.lastname: Merke
authors.forename: C C
authors.initials: CC
authors.lastname: Wan
authors.forename: N L
authors.initials: NL
authors.lastname: Catanzaro
authors.forename: W A
authors.initials: WA
authors.lastname: Zorn
mesh_terms: D001766:Blindness / Q000209:etiology; D002547:Cerebral Palsy / Q000209:etiology; D002657:Child Development; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D008607:Intellectual Disability / Q000209:etiology; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology*; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012044:Regression Analysis; D012307:Risk Factors
chemical_list: D011663:Pulmonary Surfactants