Functional assessment of a multicenter very low-birth-weight cohort at age 5 years. Newborn Lung Project.
BACKGROUND
Very low-birth-weight newborns (birth weight < or = 1500 g) experience serious neonatal complications, but long-term outcomes are not completely known. Most studies reflect an era of neonatal care that was fundamentally different from the present.


OBJECTIVE
To compare the functional level of very low-birth-weight children before and after surfactant introduction and to relate functional level to clinical and socioeconomic factors.


METHODS
Inception cohort followed up from birth to an average age of 5 years.


METHODS
Six regional neonatal intensive care units in a contiguous geographic area.


METHODS
Four hundred twenty-five very low-birth-weight children, born between August 1, 1988, and June 30, 1991, of 438 located among 626 whose parents provided follow-up information before neonatal intensive care unit discharge.


METHODS
None.


METHODS
Diagnosis of cerebral palsy and standardized scores for self-care, mobility, and social function from the Pediatric Evaluation of Disability Inventory.


RESULTS
Cerebral palsy was present in 12.6% of the children, with no change after surfactant introduction. Intraventricular hemorrhage (odds ratio, 2.3 per grade; 95% confidence interval, 1.8-2.8) and bronchopulmonary dysplasia (odds ratio, 2.3; 95% confidence interval, 1.2-4.6) were independently predictive of cerebral palsy and of functional outcome. For self-care, mobility, and social function, 11.7%, 29.5%, and 10.7% of the children, respectively, scored at least 2 SDs below the normative means. Social function was 0.25 to 0.50 normative SDs lower after general surfactant availability than before general surfactant availability.


CONCLUSIONS
While there was no increase in major disability after surfactant introduction, there may have been a decrease in social function associated with the lower neonatal mortality. Most very low-birth-weight children functioned within the normal range in everyday tasks. Several predictors of outcome were identified.
Palta
M
M
Department of Preventive Medicine, University of Wisconsin, Madison 53705, USA. palta@cornfield.epi.wisc.edu
Sadek-Badawi
M
M
Evans
M
M
Weinstein
M R
MR
McGuinnes
G
G
D001997:Bronchopulmonary Dysplasia / Q000628:therapy; D002547:Cerebral Palsy / Q000453:epidemiology; D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000254:growth & development; D007363:Intensive Care Units, Neonatal; D008297:Male; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012648:Self Care; D012959:Socioeconomic Factors; D013997:Time Factors
D011663:Pulmonary Surfactants