Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms.
BACKGROUND
Despite more than 2 decades of outcomes research after very preterm birth, clinicians remain uncertain about the extent to which neonatal morbidities predict poor long-term outcomes of extremely low-birth-weight (ELBW) infants.


OBJECTIVE
To determine the individual and combined prognostic effects of bronchopulmonary dysplasia (BPD), ultrasonographic signs of brain injury, and severe retinopathy of prematurity (ROP) on 18-month outcomes of ELBW infants.


METHODS
Inception cohort assembled for the Trial of Indomethacin Prophylaxis in Preterms (TIPP).


METHODS
A total of 910 infants with birth weights of 500 to 999 g who were admitted to 1 of 32 neonatal intensive care units in Canada, the United States, Australia, New Zealand, and Hong Kong between 1996 and 1998 and who survived to a postmenstrual age of 36 weeks.


METHODS
Combined end point of death or survival to 18 months with 1 or more of cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness.


RESULTS
Each of the neonatal morbidities was similarly and independently correlated with a poor 18-month outcome. Odds ratios were 2.4 (95% confidence interval [CI], 1.8-3.2) for BPD, 3.7 (95% CI, 2.6-5.3) for brain injury, and 3.1 (95% CI, 1.9-5.0) for severe ROP. In children who were free of BPD, brain injury, and severe ROP the rate of poor long-term outcomes was 18% (95% CI, 14%-22%). Corresponding rates with any 1, any 2, and all 3 neonatal morbidities were 42% (95% CI, 37%-47%), 62% (95% CI, 53%-70%), and 88% (64%-99%), respectively.


CONCLUSIONS
In ELBW infants who survive to a postmenstrual age of 36 weeks, a simple count of 3 common neonatal morbidities strongly predicts the risk of later death or neurosensory impairment.
Schmidt
Barbara
B
Department of Pediatrics, McMaster University, HSC 3N11E, 1200 Main St W, Hamilton, Ontario, Canada L8N 3Z5,. schmidt@mcmaster.ca
Asztalos
Elizabeth V
EV
Roberts
Robin S
RS
Robertson
Charlene M T
CM
Sauve
Reginald S
RS
Whitfield
Michael F
MF
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001766:Blindness / Q000453:epidemiology; D001927:Brain Diseases / Q000503:physiopathology*; D001997:Bronchopulmonary Dysplasia / Q000503:physiopathology*; D002547:Cerebral Palsy / Q000453:epidemiology; D003072:Cognition Disorders / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D034381:Hearing Loss / Q000453:epidemiology; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D008297:Male; D009017:Morbidity; D011379:Prognosis; D012178:Retinopathy of Prematurity / Q000503:physiopathology*; D012959:Socioeconomic Factors; D016019:Survival Analysis
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007213:Indomethacin