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PEDIATRICS Vol. 100 No. 6 December 1997, pp. 987-993

A Longitudinal Study of Developmental Outcome of Infants With Bronchopulmonary Dysplasia and Very Low Birth Weight

Received Nov 26, 1996; accepted Apr 16, 1997.

Lynn Singer*, §, parallel , Toyoko Yamashita*, Dagger , Lawrence Lilien, Marc Collin*, parallel , and Jill Baley*, §

From the Departments of * Pediatrics and Dagger  Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio;§ University Hospitals, Cleveland, Ohio; parallel  MetroHealth Medical Center, Cleveland, Ohio; and  Fairview General Hospital, Cleveland, Ohio.

Objective.  Bronchopulmonary dysplasia (BPD) is now the leading cause of lung disease in US infants. In a large regional cohort, we tested the hypothesis that despite innovations in neonatal care, very low birth weight (VLBW) infants (<1500 g) with BPD had poorer developmental outcomes than nonaffected infants during the first 3 years of life, and that BPD predicted poorer outcome beyond the effects of other risk factors.

Methods.  Three groups of infants (122 with BPD, 84 VLBW without BPD, and 123 full-term) were followed longitudinally to 3 years of age with the Bayley Scales of Mental and Motor Development. Comparison groups of VLBW infants without BPD and full-term infants did not differ in sex, race, or socioeconomic status. Statistical analyses included hierarchical and stepwise multiple regression.

Results.  Infants with BPD performed more poorly at all ages. By 3 years, cognitive and/or motor development was in the range of retardation (<70 standard score) for 21% to 22% of infants with BPD. In multiple regression analyses controlling for socioeconomic and neonatal risk conditions, BPD had an independent negative effect on motor outcome at 3 years. Neurologic risk, a summary measure of neurologic problems other than intraventricular hemorrhage, and the presence of BPD independently predicted motor delay. By 3 years, social class, race, and neurologic risk predicted mental outcome, suggesting that the specific effects of BPD are primarily on the motor domain.

Conclusions.  In VLBW infants, BPD predicts poorer motor outcome at 3 years, after control for other risks. Cohorts of infants with BPD also had higher rates of mental retardation, associated with greater neurologic and social risk. These findings underscore the need for intensive prevention and habilitation efforts for this growing group of VLBW survivors, as well as investigation into the potential role of BPD in the higher rates of learning disabilities in VLBW cohorts at school age.

Key words: bronchopulmonary dysplasia, very low birth weight, infant development, chronic lung disease, surfactant, socioeconomic status.




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