Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. 313-318 (doi:10.1542/peds.2008-0377)
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ARTICLE

Using a Count of Neonatal Morbidities to Predict Poor Outcome in Extremely Low Birth Weight Infants: Added Role of Neonatal Infection

Dirk Bassler, MD, MSca, Barbara J. Stoll, MDb, Barbara Schmidt, MD, MSca,c, Elizabeth V. Asztalos, MD, MScd, Robin S. Roberts, MScc, Charlene M. T. Robertson, MDe, Reg S. Sauve, MDf for the Trial of Indomethacin Prophylaxis in Preterms Investigators

Departments of a Pediatrics
c Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
b Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
d Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
e Neonatal and Infant Followup Clinic, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
f Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

OBJECTIVE. A count of 3 neonatal morbidities (bronchopulmonary dysplasia, brain injury, and severe retinopathy of prematurity) strongly predict the risk of death or neurosensory impairment in extremely low birth weight infants who survive to 36 weeks' postmenstrual age. Neonatal infection has also been linked with later impairment. We examined whether the addition of infection to the count of 3 neonatal morbidities further improves the prediction of poor outcome.

METHODS. We studied 944 infants who participated in the Trial of Indomethacin Prophylaxis in Preterms and survived to 36 weeks' postmenstrual age. Culture-proven sepsis, meningitis, and stage II or III necrotizing enterocolitis were recorded prospectively. We investigated the incremental prognostic importance of neonatal infection by adding terms for the different types of infection to a logistic model that already contained terms for the count of bronchopulmonary dysplasia, brain injury, and severe retinopathy. Poor outcome at 18 months of age was death or survival with 1 or more of the following: cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness.

RESULTS. There were 414 (44%) infants with at least 1 episode of infection or necrotizing enterocolitis. Meningitis and the presence of any type of infection added independent prognostic information to the morbidity-count model. The odds ratio associated with infection or necrotizing enterocolitis in this model was 50% smaller than the odds ratio associated with each count of the other 3 neonatal morbidities. Meningitis was rare and occurred in 22 (2.3%) of 944 infants.

CONCLUSIONS. In this cohort of extremely low birth weight infants who survived to 36 weeks' postmenstrual age, neonatal infection increased the risk of a late death or survival with neurosensory impairment. However, infection was a weaker predictor of poor outcome than bronchopulmonary dysplasia, brain injury, and severe retinopathy.

Key Words: extremely low birth weight infant • infection • bronchopulmonary dysplasia • brain injury • retinopathy • neurosensory impairment

Abbreviations: ELBW—extremely low birth weight • BPD—bronchopulmonary dysplasia • ROP—retinopathy of prematurity • NEC—necrotizing enterocolitis • TIPP—Trial of Indomethacin Prophylaxis in Preterms • OR—odds ratio • CI—confidence interval

Accepted Apr 23, 2008.


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