39 BIRTH ASPHYXIA IN THE VERY LOW BIRTH WEIGHT INFANT (VLBW ≤ 1500 GRAMS): IMMEDIATE AND LONGITUDINAL (2 years) OUTCOME

Abstract

The relationship of birth asphyxia (BA) to neonatal mortality & neurologic & developmental outcome at 2 yrs. of age was investigated in a large prospective study of infants with BW<1500 grams (N=525). BA was defined by an Apgar score of ≤3 at one minute &≤6 at 5 minutes. Multivariate analysis of the data included the following variables: BW, sex, socio-economic status (SES). BA, method of delivery, apnea, RDS & mechanical ventilation (MV). BA was significantly correlated with a higher neonatal mortality, more severe RDS, a greater need for MV, & neurologic & developmental outcome at 2 yrs. Indeed, BA was the only medical variable that was related to the mental development index (MDI) of the Bayley Scales. SES & sex were the most powerful correlates of MDI at 2 yrs. while none of the psycho-social variables were associated with neurologic outcome at 2 yrs. This study indicates the importance of BA on the immediate & long term outcome of the VLBW infant. It also provides evidence that it is inappropriate to assign an outcome index based on combining neuro-logic and developmental outcome. By 2 yrs. it appears that psycho-social & medical factors exert their influence relatively independently on separate systems. Medical factors impact most directly on neurologic outcome, while psycho-social variables influence developmental status. These 2 systems, while interactive, may be more independent than was thought.