School-age outcomes of very low birth weight infants in the indomethacin intraventricular hemorrhage prevention trial.
OBJECTIVE
The cohort consisted of 328 very low birth weight infants (600-1250 g birth weight) who were enrolled in the low-dose prophylactic indomethacin prevention trial and were intraventricular hemorrhage (IVH) negative at 6 postnatal hours. The objective was to determine the effects of both IVH and indomethacin on cognitive, language, and achievement performance at 8 years of age.


METHODS
The cohort was divided into 4 subgroups for analysis: indomethacin plus IVH, indomethacin no IVH, saline plus IVH, and saline with no IVH. The children were evaluated prospectively at 8 years of age with a neurologic assessment, history of school performance, and a battery of cognitive, academic, behavioral, and functional assessments.


RESULTS
Children in both IVH groups had more cerebral palsy; more hearing impairment; lower daily living skills scores; lower IQ, vocabulary, and reading and mathematics achievement test scores; and greater educational resource needs. With logistic regression analyses grade 3 to 4 IVH, periventricular leukomalacia and/or ventriculomegaly, male gender, maternal education, and language spoken in the home contributed to outcomes. No effects of indomethacin or gestational age were identified.


CONCLUSIONS
Although biological factors including IVH, ventriculomegaly, and periventricular leukomalacia contribute significantly to school age outcomes among very low birth weight survivors at 8 years of age, social and environmental factors including maternal level of education and primary language spoken in the home are also important contributors to outcome.
Vohr
Betty R
BR
Department of Pediatrics, Brown Medical School, Providence, Rhode Island, USA. betty_vohr@brown.edu
Allan
Walter C
WC
Westerveld
Michael
M
Schneider
Karen C
KC
Katz
Karol H
KH
Makuch
Robert W
RW
Ment
Laura R
LR
D002543:Cerebral Hemorrhage / Q000517:prevention & control*; D002547:Cerebral Palsy / Q000453:epidemiology; D002552:Cerebral Ventricles / Q000187:drug effects* / Q000473:pathology*; D002648:Child; D015331:Cohort Studies; D002658:Developmental Disabilities / Q000453:epidemiology; D005260:Female; D034381:Hearing Loss / Q000453:epidemiology; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000502:physiology / Q000523:psychology; D007361:Intelligence Tests / Q000706:statistics & numerical data; D007969:Leukomalacia, Periventricular / Q000453:epidemiology; D008297:Male; D020380:Needs Assessment / Q000706:statistics & numerical data; D011446:Prospective Studies; D012044:Regression Analysis
D007213:Indomethacin