Respiratory Health and Neurodevelopment in Very-Low-Birth-Weight Preterm Infants with Bronchopulmonary Dysplasia at Preschool Age
Date Issued
2009
Date
2009
Author(s)
Luo, Hong-Ji
Abstract
Study I: urpose. The purpose of this study was to examine if bronchopulmonary dysplasia (BPD) was associated with adverse developmental outcomes in very low birth weight (VLBW, birth weight <1,500 g) children at preschool age. Methods. Fifty-five VLBW children and 27 term children were examined for cognitive, motor and behavioral performance at 4 years of age using the Wechsler Preschool and Primary Scale of Intelligence-Revised, the Movement Assessment Battery for Children, and the Child Behavior Checklist/1½-5 respectively. The severity of BPD was graded according to the consensus definition of American National Institutes of Health (NIH). Results. VLBW children who had severe BPD showed a higher rate of cognitive delay (IQ<70) than VLBW children who had no, mild, or moderate BPD and term children (65% vs. 0%, 10%, 19% and 4%) and so did for motor delay (53% vs. 9%, 0%, 13% and 4%) (all p<0.05). The groups exhibited comparable performance in all domains of behavior, however. Multivariable regression analyses revealed that the severity of BPD was associated with higher motor impairment scores (ß=9.4, p=0.01); a low maternal education (ß=-13.4, p=0.02) and the presence of severe brain damage (ß=-18.4, p=0.04) were associated with lower cognitive scores; a high number of siblings was related to higher behavior problem scores in VLBW children at 4 years of age (ß=9.4, p=0.03). Conclusion. The NIH consensus definition of BPD is useful to identify VLBW children who are at increased risk of cognitive and motor disorder at preschool age. Intervention and parent education are necessary for those children with severe BPD to enhance their developmental outcomes.tudy II: urpose. The Toce clinical and radiographic scoring method is useful for early respiratory assessment in preterm infants; however, the information concerning its predictive values has been limited. This study was therefore aimed to examine the predictability of the Toce method on pulmonary outcomes in very low birth weight (VLBW, birth weight <1,500 g) preterm infants. Methods. One hundred and nine VLBW preterm infants were prospectively administered the Toce method on postnatal 14 and 28 days. Pulmonary outcomes examined included prevalence of bronchopulmonary dysplasia (BPD) at 36 weeks postmenstrual age (PMA), occurrence of respiratory morbidity within 1 year of corrected age (CA), and pulmonary function [i.e., forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1)] and distance traveled during six minutes walk test (6MWT) at 4 years of CA. Results. The predictability of severe BPD at 36 weeks PMA by the clinical score on postnatal day 14 and 28 were high [accuracy= 81-82%, positive likelihood ratio (LR+)= 3.4-5.6] and were good by the radiographic score (accuracy= 73-75%, LR+= 2.8-3.3). The prediction of post-discharge respiratory morbidity was moderate by either the clinical or radiographic score on postnatal day 14 and 28 (accuracy= 65-70%, LR+= 2.1-3.9). Furthermore, a high Toce clinical score on postnatal day 14 and 28 was each associated with a low FVC and FEV1 in pulmonary function test (ß= -15.3 to -16.9, R2= 0.26-0.31, both p<0.05) together with a short distance in 6MWT at 4 years of age (ß= -3.5 to -3.67, R2= 0.14-0.17, both p<0.05). Conclusion. The results indicate that the Toce method is a valid respiratory assessment to predict short- and long-term pulmonary outcomes in VLBW preterm infants.
Subjects
Prematurity
Bronchopulmonary dysplasia
Neurodevelopment
Respirtaory health
Preschool
Prediction
Pulmonary function test
Respiratory morbidity
Six minutes walk test
Severity
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