PEDIATRICS Vol. 79 No. 5 May 1987, pp. 670-676
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Prolonged Mechanical Ventilation and Intracranial Hemorrhage: Impact on Developmental Progress Through 18 Months in Infants Weighing 1,200 Grams or Less at Birth

Mary Ellen A. Bozynski MD1, Michael N. Nelson PhD1, Terence A. S. Matalon MD1, Karen J. O'Donnell PhD1, Patricia M. Naughton RN1, Ushanalini Vasan MD1, Werner A. Meier MD1, and Lynn Ploughman MS1

1 From the Departments of Pediatrics and Biostatistics, University of Michigan Medical Center, Ann Arbor; The Department of Pediatrics and Radiology, Rush Presbyterian St Luke's Medical Center, Chicago; and the Frank Porter Graham Child Development Center, University of North Carolina, Chapel Hill

In this prospective, longitudinal study, the relative impact of intracranial hemorrhage and prolonged mechanical ventilation on developmental progress during the first 18 months of life of infants weighing 1,200 g or less at birth was examined. A total of 159 surviving infants were divided into two groups: infants with and those without intracranial hemorrhage. These groups were then subdivided into groups of infants receiving prolonged mechanical ventilation (> 21 days) and those mechanically ventilated for 21 days or less, thus creating four subgroups. Group 1 (intracranial hemorrhage and prolonged mechanical ventilation) and group 3 (intracranial hemorrhage and no prolonged mechanical ventilation) showed no statistically significant differences for severity of intracranial hemorrhage, persistence of yentriculomegaly, or presence of periventricular leukomalacia. A repeated-measures analysis of variance demonstrated a main effect for prolonged mechanical ventilation on outcome as measured by the Bayley Mental Development Index and Bayley Psychomotor Development Index at 4, 8, 12, and 18 months of age (corrected for prematurity). Forward stepwise regression revealed prolonged mechanical ventilation to be the best predictor of Bayley indexes at all ages except 4 months of age, for which the Psychomotor Development Index was best predicted by length of hospitalization. No main effect for intracranial hemorrhage was demonstrated, but the motor performance of infants with intracranial hemorrhage declined significantly with age. By contrast prolonged mechanical ventilation was associated with uniformly poor performance at every age and serves as a powerful marker for poor developmental progress during the first 18 months of life in infants weighing 1,200 g or less at birth.

Key Words: prolonged mechanical ventilation • intracranial hemorrhage • premature infant

Submitted on July 24, 1986
Accepted on November 7, 1986




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