Published online November 5, 2007
PEDIATRICS Vol. 120 No. 6 December 2007, pp. e1512-e1519 (doi:10.1542/10.1542/peds.2007-0354)
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ARTICLE

Major Congenital Anomalies Place Extremely Low Birth Weight Infants at Higher Risk for Poor Growth and Developmental Outcomes

Rachel V. Walden, MDa, Sarah C. Taylor, BSPHb, Nellie I. Hansen, MPHb, W. Kenneth Poole, PhDb, Barbara J. Stoll, MDc, Dianne Abuelo, MDd, Betty R. Vohr, MDe for the National Institute of Child Health and Human Development Neonatal Research Network

a Pediatrix Medical Group of Dallas, Richardson, Texas
b Statistics and Epidemiology Division, RTI International, Research Triangle Park, North Carolina
c Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
d Department of Pediatrics, Genetics Counseling Center, Rhode Island Hospital and Hasbro Children's Hospital/Warren Alpert School of Medicine of Brown University, Providence, Rhode Island
e Department of Pediatrics, Women and Infants Hospital/Warren Alpert School of Medicine of Brown University, Providence, Rhode Island

BACKGROUND. Studies of growth and neurodevelopmental impairment in extremely low birth weight infants often exclude infants with major congenital anomalies; thus, there are few outcome data available on these infants.

OBJECTIVES. The purpose of this work was to compare growth and neurodevelopmental outcomes of extremely low birth weight infants with major anomalies to extremely low birth weight infants without these findings. It was hypothesized that infants with severe anomalies would have worse growth, neurodevelopmental, and survival outcomes.

METHODS. A retrospective cohort analysis was performed on 5920 extremely low birth weight infants surviving beyond 12 hours of life at 19 neonatal network centers between 1998 and 2001. Infants with significant anomalies were more likely to die before 18 to 22 months' corrected age. A total of 3705 children underwent neurodevelopmental and anthropometric evaluation at 18 to 22 months' corrected age. Statistical significance for unadjusted comparisons was determined by Wilcoxon tests for continuous variables and {chi}2 or Fisher's exact tests for categorical variables. Regression models were used to compare the outcomes after adjusting for potential confounders.

RESULTS. Children with major congenital anomalies were more likely to have Bayley Mental Development Index scores of ≤70, Psychomotor Development Index scores of ≤70, neurodevelopmental impairment, moderate-to-severe cerebral palsy, length in the ≤10th percentile, head circumference in the ≤10th percentile, more rehospitalizations, and higher rates of early intervention use at 18 to 22 months' corrected age.

CONCLUSIONS. At 18 to 22 months' corrected age, extremely low birth weight infants born with major anomalies have nearly twice the risk for neurodevelopmental impairment, increased risk of poor growth, and >3 times greater risk of rehospitalization when compared with extremely low birth weight infants without major anomalies. This information may be valuable for counseling parents regarding the outcomes of these infants and for the facilitation of appropriate support and intervention services.

Key Words: congenital anomalies • extremely low birth weight • outcomes

Abbreviations: ELBW—extremely low birth weight • BW—birth weight • CA—corrected age • NRN—Neonatal Research Network • GA—gestational age • SGA—small for gestational age • RDS—respiratory distress syndrome • PDA—patent ductus arteriosus • IVH—intraventricular hemorrhage • PVL—periventricular leukomalacia • CLD—chronic lung disease • CNS—central nervous system • PDI—Psychomotor Development Index • MDI—Mental Development Index • NDI—neurodevelopmental impairment • HC—head circumference • RR—relative risk

Accepted May 23, 2007.


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