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PEDIATRICS Vol. 111 No. 4 April 2003, pp. e340-e346

ELECTRONIC ARTICLE

School-Age Outcomes of Very Low Birth Weight Infants in the Indomethacin Intraventricular Hemorrhage Prevention Trial

Betty R. Vohr, MD*, Walter C. Allan, MD#, Michael Westerveld, PhD||, Karen C. Schneider, MPH{ddagger}, Karol H. Katz, MS, Robert W. Makuch, PhD and Laura R. Ment, MD{ddagger},§

* Department of Pediatrics, Brown Medical School, Providence, Rhode Island
{ddagger} Departments of Pediatrics
§ Neurology
|| Neurosurgery
Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut
# Department of Neurology, Maine Medical Center, Portland, Maine

--> Objective. The cohort consisted of 328 very low birth weight infants (600–1250 g birth weight) who were enrolled in the low-dose prophylactic indomethacin prevention trial and were intraventricular hemorrhage (IVH) negative at 6 postnatal hours. The objective was to determine the effects of both IVH and indomethacin on cognitive, language, and achievement performance at 8 years of age.

Methods. The cohort was divided into 4 subgroups for analysis: indomethacin plus IVH, indomethacin no IVH, saline plus IVH, and saline with no IVH. The children were evaluated prospectively at 8 years of age with a neurologic assessment, history of school performance, and a battery of cognitive, academic, behavioral, and functional assessments.

Results. Children in both IVH groups had more cerebral palsy; more hearing impairment; lower daily living skills scores; lower IQ, vocabulary, and reading and mathematics achievement test scores; and greater educational resource needs. With logistic regression analyses grade 3 to 4 IVH, periventricular leukomalacia and/or ventriculomegaly, male gender, maternal education, and language spoken in the home contributed to outcomes. No effects of indomethacin or gestational age were identified.

Conclusions. Although biological factors including IVH, ventriculomegaly, and periventricular leukomalacia contribute significantly to school age outcomes among very low birth weight survivors at 8 years of age, social and environmental factors including maternal level of education and primary language spoken in the home are also important contributors to outcome.

Key Words: very low birth weight • school age outcomes • indomethacin • intraventricular hemorrhage • performance

Abbreviations: IVH, intraventricular hemorrhage • CP, cerebral palsy • VLBW, very low birth weight • ECHO, cranial echoencephalography • BPD, bronchopulmonary dysplasia • VM, ventriculomegaly • PVL, periventricular leukomalacia • WISC-III, Wechsler Intelligence Scale for Children-Third Edition • PPVT-R, Peabody Picture Vocabulary Test-Revised • CBCL, Child Behavior Checklist • PIAT-R, Peabody Individual Achievement Test-Revised

Received for publication Aug 8, 2000; Accepted Nov 12, 2000.


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