Outcomes of extremely low birth weight (<1 kg) and extremely low gestational age (<28 weeks) infants with bronchopulmonary dysplasia: effects of practice changes in 2000 to 2003.
OBJECTIVE
The goal was to evaluate whether changes in neonatal intensive care have improved outcomes for children with bronchopulmonary dysplasia (oxygen dependence at corrected age of 36 weeks).


METHODS
We compared outcomes of extremely low birth weight (<1 kg) and extremely low gestational age (<28 weeks) infants with bronchopulmonary dysplasia between 2 periods (period I, 1996-1999: extremely low birth weight, n = 122; extremely low gestational age, n = 118; period II, 2000-2003: extremely low birth weight, n = 109; extremely low gestational age, n = 107).


RESULTS
For both groups, significant practice changes between period I and period II included increased prenatal and decreased postnatal steroid therapy and increased surfactant therapy, indomethacin therapy, and patent ductus arteriosus ligation. Significant morbidity changes included decreased rates of severe cranial ultrasound abnormalities and increased rates of ventilator dependence. Rates of bronchopulmonary dysplasia did not change (52% vs 53%). Follow-up evaluation revealed significantly lower rates of neurosensory abnormalities during period II (extremely low birth weight: 29% vs 16%; extremely low gestational age: 31% vs 16%). There were no changes in rates of Mental Developmental Index scores of <70 (extremely low birth weight: 42% vs 42%; extremely low gestational age: 37% vs 45%) or overall developmental impairment (extremely low birth weight: 51% vs 49%; extremely low gestational age: 50% vs 51%). For the extremely low gestational age group, predictors of neurosensory abnormalities were severe cranial ultrasound abnormality and postnatal steroid therapy. Predictors of overall impairment included severe cranial ultrasound abnormalities, ventilator dependence, postnatal steroid therapy, and patent ductus arteriosus ligation. For the extremely low birth weight group, the only predictor of neurosensory abnormalities was severe cranial ultrasound abnormality. Predictors of overall impairment included multiple birth, ventilator dependence, and severe cranial ultrasound abnormalities.


CONCLUSIONS
Neurosensory outcomes of infants with bronchopulmonary dysplasia improved during 2000 to 2003 but overall neurodevelopmental outcomes did not change.
Kobaly
Kristen
K
Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA.
Schluchter
Mark
M
Minich
Nori
N
Friedman
Harriet
H
Taylor
Hudson Gerry
HG
Wilson-Costello
Deanne
D
Hack
Maureen
M
D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002658:Developmental Disabilities / Q000209:etiology / Q000401:mortality / Q000628:therapy; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000592:standards* / Q000639:trends; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011336:Probability; D011379:Prognosis; D011596:Psychomotor Disorders / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome