title: Outcomes of extremely low birth weight infants with bronchopulmonary dysplasia: impact of the physiologic definition.
abstract: OBJECTIVE
  We compared neurodevelopmental outcomes of extremely low birth weight (ELBW) infants with and without bronchopulmonary dysplasia (BPD), using the physiologic definition.
  
  
  METHODS
  ELBW (birth weights<1000 g) infants admitted to the Neonatal Research Network centers and hospitalized at 36 weeks postmenstrual age (n=1189) were classified using the physiologic definition of BPD. Infants underwent Bayley III assessment at 18-22 months corrected age. Multivariable logistic regression was used to determine the association between physiologic BPD and cognitive impairment (score<70).
  
  
  RESULTS
  BPD by the physiologic definition was diagnosed in 603 (52%) infants, 537 of whom were mechanically ventilated or on FiO(2)>30% and 66 who failed the room air challenge. Infants on room air (n=505) and those who passed the room air challenge (n=51) were classified as "no BPD" (n=556). At follow up, infants with BPD had significantly lower mean weight and head circumference. Moderate to severe cerebral palsy (7 vs. 2.1%) and spastic diplegia (7.8 vs. 4.1%) and quadriplegia (3.9 vs. 0.9%) phenotypes as well as cognitive (12.8 vs. 4.6%) and language scores<70 (24.2 vs. 12.3%) were significantly more frequent in those with BPD compared to those without BPD. BPD was independently associated (adjusted OR 2.4; 95% CI 1.40-4.13) with cognitive impairment.
  
  
  CONCLUSIONS
  Rates of adverse neurodevelopmental outcomes in early childhood were significantly higher in those with BPD. BPD by the physiologic definition was independently associated with cognitive impairment using Bayley Scales III. These findings have implications for targeted post-discharge surveillance and early intervention.
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, MI, USA. gnatara@med.wayne.edu
authors.forename: Girija
authors.initials: G
authors.lastname: Natarajan
authors.forename: Athina
authors.initials: A
authors.lastname: Pappas
authors.forename: Seetha
authors.initials: S
authors.lastname: Shankaran
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Kendrick
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
authors.forename: Abbot R
authors.initials: AR
authors.lastname: Laptook
authors.forename: Edward F
authors.initials: EF
authors.lastname: Bell
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stoll
authors.forename: Nancy
authors.initials: N
authors.lastname: Newman
authors.forename: Ellen C
authors.initials: EC
authors.lastname: Hale
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bara
authors.forename: Michele C
authors.initials: MC
authors.lastname: Walsh
mesh_terms: D000328:Adult; D000465:Algorithms; D001997:Bronchopulmonary Dysplasia / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D061345:Early Medical Intervention; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000502:physiology; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D008297:Male; D011379:Prognosis; D009626:Terminology as Topic; D016896:Treatment Outcome; D055815:Young Adult