68 Prognostic Value of Bronchopulmonary Dysplasia, Brain Injury and Severe Retinopathy in Determining Neurodevelopmental Outcome in Extremely Low Birth Weight Infants

Abstract

Extremely low birth weight infants (ELBW) are at high risk for developmental impairment. Predicting such risk for ELBW survivors is difficult. Recently, Schmidt et al. proposed such risks can be accurately predicted for ELBW infants surviving to 36 weeks corrected gestational age (cGA), using a simple numerical count of three specific neonatal morbidities: bronchopulmonary dysplasia (BPD) – defined as supplemental oxygen at 36 weeks cGA, brain injury – defined as the presence of Grade 3 or 4 intra-ventricular haemorrhage, porencephalic cyst, ventriculomegaly, periventricular leukomalacia, or hydrocephalus, and severe retinopathy of prematurity (ROP) – defined as bilateral Grade 3 or 4 or threshold disease. We evaluated this prediction rule using a regional follow-up database of ELBW infants. The study included a total of 225 ELBW infants (birth weight 500–999 g) who were born in Manitoba, Canada between 1992 and December 2001 and survived to 36 weeks cGA. The morbidities of interest (BPD, brain injury, and ROP) were abstracted. Poor outcome was defined as death or neurodevelop-mental impairment (the presence of one or more of cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness by 14–26 months of age cGA). Of the 225 infants, 86 developed BPD (38.2%), 80 (35.6%) had a brain injury, 82 infants (36.4%) had severe ROP. Five of the 225 infants died after 36 weeks cGA. The overall risk of death or poor neurodevelopmental impairment was 46.2%. Without any of the three neonatal morbidities, the risk of poor outcome was 22%. There was an increase in risk of poor outcome with increasing number of neonatal morbidities. The risk of poor outcome with any single neonatal morbidity, any two neonatal morbidities and any three neonatal morbidities was 37.7%, 75% and 84.8% respectively (Figure 1). We conclude that the simple count of the three neonatal morbidities suggested by Schmidt et al. can be a useful predictor of the risk of death or neurodevelopmental impairment in ELBW infants surviving to 36 weeks cGA. Percentage of Poor Outcome (14–26 Months) in Study Infants With 0, 1, 2, and All 3 Neonatal Morbidities. Dotted line indicates overall percentage of poor outcome (46.2%). 0 morbidity=22%, 1 morbidity=37.7%, 2 morbidities=75%, 3 morbidities =84.8% of poor outcome Percentage of Poor Outcome (14–26 Months) in Study Infants With 0, 1, 2, and All 3 Neonatal Morbidities. Dotted line indicates overall percentage of poor outcome (46.2%). 0 morbidity=22%, 1 morbidity=37.7%, 2 morbidities=75%, 3 morbidities =84.8% of poor outcome