The clustering of disorders in infants born before the 28th week of gestation.
OBJECTIVE
To see whether disorders prevalent in infants born extremely preterm cluster.


METHODS
Observational cohort study.


METHODS
University-affiliated newborn intensive care nurseries.


METHODS
One thousand two hundred and twenty-three infants born before the 28th week of gestation who survived until 36 weeks postmenstrual age when the diagnosis of bronchopulmonary dysplasia (BPD) could be made.


METHODS
None.


METHODS
Cerebral white matter damage (an echolucent lesion, or moderate or severe ventriculomegaly on a protocol cranial ultrasound scan), BPD, retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC) and early and late bacteremia.


RESULTS
After adjustment for gestational age, children who had severe NEC (Bell stage IIIb) were at increased risk of cerebral white matter damage, severe ROP (stage 3+), and severe BPD (defined as both oxygen and ventilator dependent). Children who had early bacteremia were at increased risk of late bacteremia and severe ROP. Those who had severe ROP were at increased risk of severe BPD and both early and late bacteremia.


CONCLUSIONS
Necrotizing enterocolitis is the disorder common to most of the clusters, but we do not know if its onset occurred before the others. Organ-damage-promoting substances, however, have been found in the circulation of newborn animals with bowel inflammation, supporting the view that NEC contributes to the damage of other organs.
Leviton
Alan
A
Neurology Department, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA. alan.leviton@childrens.harvard.edu
Dammann
Olaf
O
Engelke
Stephen
S
Allred
Elizabeth
E
Kuban
Karl C K
KC
O'Shea
T Michael
TM
Paneth
Nigel
N
D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology; D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis / Q000453:epidemiology; D002540:Cerebral Cortex / Q000473:pathology; D016000:Cluster Analysis; D015331:Cohort Studies; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D012178:Retinopathy of Prematurity / Q000175:diagnosis / Q000453:epidemiology; D018570:Risk Assessment; D012720:Severity of Illness Index