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Neurodevelopmental Outcomes
Neurodevelopmental and Functional Outcomes of Extremely Low Birth Weight Infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. Vohr BR, Wright LL, Dusick AM, et al. Pediatrics 2000; 105:1216-26).
This study reports the neurodevelopmental, neurosensory and functional outcomes at 18-22 months corrected age, of 1151 ELBW (401-1000g) survivors born in 1993 and 1994 and cared for in 12 participating centers. Twenty-five percent of children had an abnormal neurologic examination, 37% had a Bayley II Mental Developmental Index < 70, 9% had vision impairment, and 11% had hearing impairment. Neurologic, developmental, neurosensory and functional morbidities increased with decreasing birth weight. Factors significantly associated with increased neurodevelopmental morbidity included chronic lung disease, grades 3-4 IVH / PVL, steroids for chronic lung disease, NEC, and male gender. Factors significantly associated with decreased morbidity included increased birth weight, female gender, high maternal education and white race.
Comment. The optimist in me was reassured that most (51%) of the ELBW premies in this very large study had normal neurodevelopmental and sensory evaluations at 18-22 months of age. The realist in me is reminded of the importance of monitoring all ELBW infants after discharge for neurodevelopmental problems to ensure that their families receive appropriate support and intervention services to optimize outcome potential. Because of the large sample size (1151 infants from 12 centers), the data could be analyzed to report outcomes of the cohort by 100 gm birth weight sub-groups and to adjust for multiple risk factors for adverse outcome. This will provide birth-weight specific data that can be used when counseling parents about the risks for adverse neurodevelopmental outcomes in their ELBW babies.
Andrew B. Kairalla MD