Published online December 31, 2007
PEDIATRICS Vol. 121 No. 1 January 2008, pp. 73-81 (doi:10.1542/peds.2007-1444)
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ARTICLE

Outcomes of Extremely Low Birth Weight (<1 kg) and Extremely Low Gestational Age (<28 Weeks) Infants With Bronchopulmonary Dysplasia: Effects of Practice Changes in 2000 to 2003

Kristen Kobaly, BS, Mark Schluchter, PhD, Nori Minich, BS, Harriet Friedman, MA, Hudson Gerry Taylor, PhD, Deanne Wilson-Costello, MD and Maureen Hack, MBChB

Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio

OBJECTIVE. The goal was to evaluate whether changes in neonatal intensive care have improved outcomes for children with bronchopulmonary dysplasia (oxygen dependence at corrected age of 36 weeks).

METHODS. We compared outcomes of extremely low birth weight (<1 kg) and extremely low gestational age (<28 weeks) infants with bronchopulmonary dysplasia between 2 periods (period I, 1996–1999: extremely low birth weight, n = 122; extremely low gestational age, n = 118; period II, 2000–2003: extremely low birth weight, n = 109; extremely low gestational age, n = 107).

RESULTS. For both groups, significant practice changes between period I and period II included increased prenatal and decreased postnatal steroid therapy and increased surfactant therapy, indomethacin therapy, and patent ductus arteriosus ligation. Significant morbidity changes included decreased rates of severe cranial ultrasound abnormalities and increased rates of ventilator dependence. Rates of bronchopulmonary dysplasia did not change (52% vs 53%). Follow-up evaluation revealed significantly lower rates of neurosensory abnormalities during period II (extremely low birth weight: 29% vs 16%; extremely low gestational age: 31% vs 16%). There were no changes in rates of Mental Developmental Index scores of <70 (extremely low birth weight: 42% vs 42%; extremely low gestational age: 37% vs 45%) or overall developmental impairment (extremely low birth weight: 51% vs 49%; extremely low gestational age: 50% vs 51%). For the extremely low gestational age group, predictors of neurosensory abnormalities were severe cranial ultrasound abnormality and postnatal steroid therapy. Predictors of overall impairment included severe cranial ultrasound abnormalities, ventilator dependence, postnatal steroid therapy, and patent ductus arteriosus ligation. For the extremely low birth weight group, the only predictor of neurosensory abnormalities was severe cranial ultrasound abnormality. Predictors of overall impairment included multiple birth, ventilator dependence, and severe cranial ultrasound abnormalities.

CONCLUSIONS. Neurosensory outcomes of infants with bronchopulmonary dysplasia improved during 2000 to 2003 but overall neurodevelopmental outcomes did not change.

Key Words: preterm • bronchopulmonary dysplasia • neurologic handicap

Abbreviations: BPD—bronchopulmonary dysplasia • CA—corrected age • ELBW—extremely low birth weight • ELGA—extremely low gestational age • MDI—Mental Developmental Index • PDA—patent ductus arteriosus • PDI—Psychomotor Developmental Index

Accepted Jun 22, 2007.