Top

Published in:

01-01-2008 | Original Paper

Outcome of extremely low birth weight survivors at school age: the influence of perinatal parameters on neurodevelopment

Authors: Achim-Peter Neubauer, Wolfgang Voss, Evelyn Kattner

Published in: European Journal of Pediatrics | Issue 1/2008

Abstract

Extremely low birth weight (ELBW) is associated with impaired neurodevelopmental outcome in infancy. Information on the long-term cognitive and neurological consequences of ELBW is scarce. We aimed to identify the perinatal and neonatal factors of ELBW infants associated with adverse cognitive and neurological outcome at school age. A regional cohort of 135 ELBW infants born between 1993 and 1998 was prospectively evaluated at 3, 6, 12, and 18 months postmenstrual age and at yearly intervals up to age 10 years. The comprehensive follow-up programme for high-risk infants included neurological examinations and psychometric evaluations. According to the overall results of these tests, children were classified as either being normal or having minor or major impairment. At a mean age of 8.4 (SD: 1.6) years, 43% of children had survived without any impairment. Minor impairment was diagnosed in 39% and major impairment in 18% of assessed children. The proportion of disabled school children rose with decreasing gestational age. The following neonatal complications were significant risk factors for developing major or minor impairment at school age: an increase in head circumference <6 mm per week (OR 4.0, 95% CI: 1.1–14.8), parenteral nutrition ≥6 weeks (OR 2.5, 95% CI: 1.1–6.0), and mechanical ventilation >14 days (OR 2.3, 95% CI: 1.0–5.1). High-grade intraventricular haemorrhage (IVH) and/or PVL (OR 13.3, 95% CI: 4.0–44.9), neonatal seizures (OR 5.2, 95% CI: 1.2–22.4) and bowel perforation, and/or necrotizing enterocolitis (OR 4.4, 95% CI: 1.1–17.0) were significant risk factors for developing major impairment. In spite of the relatively large proportion of normal children, ELBW remains an important risk factor for neurodevelopmental impairment at school age. Thus, measures to prevent complications such as necrotizing enterocolitis, cerebral haemorrhage, and undernutrition remain important goals for neonatal intensive care.

Ambalavanan N, Nelson KG, Alexander G, Johnson SE, Biasini F, Carlo WA (2000) Prediction of neurologic morbidity in extremely low birth weight infants. J Perinatol 20:496–503PubMedCrossRef

Anderson P, Doyle LW, Victorian Infant Collaborative Study Group (2003) Neurobehavioral outcomes of school-age children born extremely low birth weight or very preterm in the 1990s. JAMA 289:3264–3272PubMedCrossRef

Berseth CL, Bisquera JA, Paje VU (2003) Prolonging small feeding volumes early in life decreases the incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics 111:529–534PubMedCrossRef

Blitz RK, Wachtel RC, Blackmon L, Berenson-Howard J (1997) Neurodevelopmental outcome of extremely low birth weight infants in Maryland. Md Med J 46:18–24PubMed

Bowen JR, Starte DR, Arnold JD, Simmons JL, Ma PJ, Leslie GI (1993) Extremely low birthweight infants at 3 years: a developmental profile. J Paediatr Child Health 29:276–281PubMed

Cooke RWI, Foulder-Hughes L (2003) Growth impairment in the very preterm and cognitive and motor performance at 7 years. Arch Dis Child 88:482–487PubMedCrossRef

Cummings JJ, D’Eugenio DB, Gross SJ (1989) A controlled trial of dexamethasone in preterm infants at high risk for bronchopulmonary dysplasia. N Engl J Med 320:1505–1510PubMedCrossRef

D’Angio CT, Sinkin RA, Stevens TP, Landfish NK, Merzbach JL, Ryan RM, Phelps DL, Palumbo DR, Myers GJ (2002) Longitudinal, 15-year follow-up of children born at less than 29 weeks’ gestation after introduction of surfactant therapy into a region: neurologic, cognitive, and educational outcomes. Pediatrics 110:1094–1102PubMedCrossRef

De Vries LS, Eken P, Dubowitz LMS (1992) The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res 49:1–6PubMedCrossRef

10.

Doyle LW, Anderson PJ; Victorian Infant Collaborative Study group (2005) Improved neurosensory outcome at 8 years of age of extremely low birthweight children born in Victoria over 3 distinct eras. Arch Dis Child Fetal Neonatal Ed 90:484–488CrossRef

11.

Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK (2006) Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 117:1253–1261PubMedCrossRef

12.

Escobar GJ, Littenberg B, Petitti DB (1991) Outcome among surviving very low birthweight infants: a meta-analysis. Arch Dis Child 66:204–211PubMed

13.

Evans RA, Thureen P (2001) Early feeding strategies in preterm and critically ill neonates. Neonatal Netw 20:7–18PubMed

14.

Farooqi A, Hagglof B, Sedin G, Gothefors L, Serenius F (2006) Chronic conditions, functional limitations, and special health care needs in 10- to 12-year-old children born at 23 to 25 weeks’ gestation in the 1990s: a Swedish national prospective follow-up study. Pediatrics 118:e1466–e1477PubMedCrossRef

15.

Flidel-Rimon O, Friedman S, Lev E, Juster-Reicher A, Amitay M, Shinwell ES (2004) Early enteral feeding and nosocomial sepsis in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 89:F289–F292PubMedCrossRef

16.

Garcia-Alix A, Saenz-de Pipaon M, Martinez M, Salas-Hernandez S, Quero J (2004) [Ability of neonatal head circumference to predict long-term neurodevelopmental outcome] TT-Utilidad del perimetro cefalico en el recien nacido para anticipar problemas en el neurodesarrollo. Rev Neurol 39:548–554PubMed

17.

Hack M, Friedman H, Fanaroff AA (1996) Outcomes of extremely low birth weight infants. Pediatrics 98:931–937PubMed

18.

Hack M, Taylor HG, Klein N, Eiben R, Schatschneider C, Mercuri-Minich N (1994) School-age outcomes in children with birth weights under 750 g. N Engl J Med 331:753–759PubMedCrossRef

19.

Hack M, Taylor HG, Drotar D, Schluchter M, Cartar L, Andreias L, Wilson-Costello D, Klein N (2005) Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s. JAMA 294:318–325PubMedCrossRef

20.

Hack M, Wilson-Costello D, Friedman H, Taylor GH, Schluchter M, Fanaroff AA (2000) Neurodevelopment and predictors of outcomes of children with birth weights of less than 1,000 g: 1992–1995. Arch Pediatr Adolesc Med 154:725–731PubMed

21.

Halliday HL (2001) The effect of postnatal steroids on growth and development. J Perinat Med 29:281–285PubMedCrossRef

22.

Hay WW Jr (1994) Nutritional requirements of extremely low birthweight infants. Acta Paediatr Suppl 402:94–99PubMed

23.

Hintz SR, Kendrick DE, Stoll BJ, Vohr BR, Fanaroff AA, Donovan EF, Poole WK, Blakely ML, Wright L, Higgins R (2005) Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis. Pediatrics 115:696–703PubMedCrossRef

24.

Jobe AH, Bancalari E (2001) Bronchopulmonary dysplasia. Am J Respir Crit Care Med 163:1723–1729PubMed

25.

Lee KS, Kim BI, Khoshnood B, Hsieh HL, Chen TJ, Herschel M, Mittendorf R (1995) Outcome of very low birth weight infants in industrialized countries: 1947–1987. Am J Epidemiol 141:1188–1193PubMed

26.

Marlow N, Wolke D, Bracewell MA, Samara M (2005) Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 352:9–19PubMedCrossRef

27.

Melchers P, Preuss U (1991) K-ABC: Kaufman Assessment Battery for children. Deutschsprachige Fassung. Swets & Zeitlinger, Frankfurt

28.

Mikkola K, Ritari N, Tommiska V, Salokorpi T, Lehtonen L, Tammela O, Paakkonen L, Olsen P, Korkman M, Fellman V (2005) Neurodevelopmental outcome at 5 years of age of a national cohort of extremely low birth weight infants who were born in 1996–1997. Pediatrics 116:1391–1400PubMedCrossRef

29.

Papile LA, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 92:529–534PubMedCrossRef

30.

Patole SK, de Klerk N (2005) Impact of standardised feeding regimens on incidence of neonatal necrotising enterocolitis: a systematic review and meta-analysis of observational studies. Arch Dis Child Fetal Neonatal Ed 90:F147–F151PubMedCrossRef

31.

Patra K, Wilson-Costello D, Taylor HG, Mercuri-Minich N, Hack M (2006) Grades I-II intraventricular hemorrhage in extremely low birth weight infants: effects on neurodevelopment. J Pediatr 149:169–173PubMedCrossRef

32.

Robertson CM, Hrynchyshyn GJ, Etches PC, Pain KS (1992) Population-based study of the incidence, complexity, and severity of neurologic disability among survivors weighing 500 through 1,250 grams at birth: a comparison of two birth cohorts. Pediatrics 90:750–755PubMed

33.

Salhab WA, Perlman JM, Silver L, Sue BR (2004) Necrotizing enterocolitis and neurodevelopmental outcome in extremely low birth weight infants <1,000 g. J Perinatol 24:534–540PubMedCrossRef

34.

Sherlock RL, Anderson PJ, Doyle LW; Victorian Infant Collaborative Study Group (2005) Neurodevelopmental sequelae of intraventricular haemorrhage at 8 years of age in a regional cohort of ELBW/very preterm infants. Early Hum Dev 81:909–916PubMedCrossRef

35.

Sonntag J, Grimmer I, Scholz T, Metze B, Wit J, Obladen M (2000) Growth and neurodevelopmental outcome of very low birthweight infants with necrotizing enterocolitis. Acta Paediatr 89:528–532PubMedCrossRef

36.

Tellegen PJ, Winkel M, Wijnberg-Williams BJ (1996) Snijders-Oomen Non-verbaler Intelligenztest (SON-R 2 1/2–7). Deutschsprachige Fassung. Swets & Zeitlinger, Frankfurt

37.

Tewes U, Rossmann R, Schallberger U (1999) Der Hamburg-Wechsler-Intelligenztest für Kinder (HAWIK-III). Huber-Verlag, Bern

38.

The Victorian Infant Collaborative Study Group (1995) Neurosensory outcome at 5 years and extremely low birthweight. Arch Dis Child Fetal Neonatal Ed 73:F143–F146

39.

The Victorian Infant Collaborative Study Group (1997) Improved outcome into the 1990s for infants weighing 500–999 g at birth. Arch Dis Child Fetal Neonatal Ed 77:F91–F94

40.

Touwen BCL (1979) Examination of the child with minor neurological dysfunction. Clin Dev Med 58:8–107

41.

Troche B, Harvey-Wilkes K, Engle WD, Nielsen HC, Frantz ID 3rd, Mitchell ML, Hermos RJ (1995) Early minimal feedings promote growth in critically ill premature infants. Biol Neonate 67:172–181PubMedCrossRef

42.

Vohr BR, Wright LL, Poole WK, McDonald SA (2005) Neurodevelopmental outcomes of extremely low birth weight infants <32 weeks’ gestation between 1993 and 1998. Pediatrics 16:635–643CrossRef

43.

Voigt M, Schneider KT, Jaehrig K (1996) [Analysis of a 1992 birth sample in Germany. 1: new percentile values of the body weight of newborn infants] TT-Analyse des Geburtengutes des Jahrgangs 1992 der Bundesrepublik Deutschland. Teil 1: Neue Perzentilwerte für die Körpermasse von Neugeborenen. Geburtshilfe Frauenheilkd 56:550–558PubMedCrossRef

44.

Voss W, Neubauer AP, Wachtendorf M, Verhey JF, Kattner E (2007) Neurodevelopmental outcome in extremely low birth weight infants-What is the minimum age for reliable developmental prognosis? Acta Paediatr: in press

45.

Walsh MC, Kliegman RM, Hack M (1989) Severity of necrotizing enterocolitis: influence on outcome at 2 years of age. Pediatrics 84:808–814PubMed

46.

Wilson-Costello D, Friedman H, Minich N, Fanaroff AA, Hack M (2005) Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants in the 1990s. Pediatrics 115:997–1003PubMedCrossRef

47.

Wilson-Costello D, Friedman H, Minich N, Siner B, Taylor G, Schluchter M, Hack M (2007) Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000–2002. Pediatrics 119:37–45PubMedCrossRef

Title: Outcome of extremely low birth weight survivors at school age: the influence of perinatal parameters on neurodevelopment
Authors: Achim-Peter Neubauer
Wolfgang Voss
Evelyn Kattner
Publication date: 01-01-2008
Publisher: Springer-Verlag
Published in: European Journal of Pediatrics / Issue 1/2008
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-007-0435-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Outcome of extremely low birth weight survivors at school age: the influence of perinatal parameters on neurodevelopment

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2008

Varicella vaccination in Europe: are we ready for a universal childhood programme?

A child with acute appendicitis

Are glutathione S-transferase gene polymorphisms linked to neonatal jaundice?

Assessment of febrile seizures in children

Clinical manifestations of human coronavirus NL63 infection in children in Taiwan

James P. Nataro, Paul S. Cohen, Harry L.T. Mobley, Jefferey N. Weiser (eds): Colonization of mucosal surfaces