Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of severe neonatal morbidities on long term outcome in extremely low birthweight infants

  • Koo, Kyo-Yeon (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital) ;
  • Kim, Jeong-Eun (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital) ;
  • Lee, Soon-Min (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital) ;
  • NamGung, Ran (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital) ;
  • Park, Min-Soo (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital) ;
  • Park, Kook-In (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital) ;
  • Lee, Chul (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital)
  • Received : 2009.09.02
  • Accepted : 2009.11.02
  • Published : 2010.06.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: To assess the validity of individual and combined prognostic effects of severe bronchopulmonary dysplasia (BPD), brain injury, retinopathy of prematurity (ROP), and parenteral nutrition associated cholestasis(PNAC). Methods: We retrospectively analyzed the medical records of 80 extremely low birthweight (ELBW) infants admitted to the neonatal intensive care unit (NICU) of the Severance Children's Hospital, and who survived to a postmenstrual age of 36 weeks. We analyzed the relationship between 4 neonatal morbidities (severe BPD, severe brain injury, severe ROP, and severe PNAC) and poor outcome. Poor outcome indicated death after a postmenstrual age of 36 weeks or survival with neurosensory impairment (cerebral palsy, delayed development, hearing loss, or blindness) between 18 and 24 months of corrected age. Results: Each neonatal morbidity correlated with poor outcome on univariate analysis. Multiple logistic regression analysis revealed that the odds ratios (OR) were 4.9 (95% confidence interval [CI], 1.0-22.6; $P$=0.044) for severe BPD, 13.2 (3.0-57.3; $P$<.001) for severe brain injury, 5.3 (1.6-18.1; $P$=0.007) for severe ROP, and 3.4 (0.5-22.7; $P$=0.215) for severe PNAC. Severe BPD, brain injury, and ROP were significantly correlated with poor outcome, but not severe PNAC. By increasing the morbidity count, the rate of poor outcome was significantly increased (OR 5.2; 95% CI, 2.2-11.9; $P$<.001). In infants free of the above-mentioned morbidities, the rate of poor outcome was 9%, while the corresponding rates in infants with 1, 2, and more than 3 neonatal morbidities were 46%, 69%, and 100%, respectively. Conclusion: In ELBW infants 3 common neonatal mornidifies, severe BPD, brain injury and ROP, strongly predicts the risk of poor outcome.

Keywords

References

  1. Kim KS, Bae CW. Trends in survival rate for very low birth weight infants and extremely low birth weight infants in Korea (1967-2007). Korean J Pediatr 2008;51:237-42. https://doi.org/10.3345/kjp.2008.51.3.237
  2. Kusuda S, Fugimura M, Sakuma I, Aotani H, Kabe K, Itani Y, et al. Morbidity and mortality of infants with very low birth weight in Japan: center variation. Pediatrics 2006;118:e1130-8. https://doi.org/10.1542/peds.2005-2724
  3. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et al. Trends in neonatal morbidity and mortality for very low birth weight infants. Am J Obstet Gynecol 2007;196:147.e1-8. https://doi.org/10.1016/j.ajog.2006.09.014
  4. Wilson-Costello D, Friedman H, Minich N, Siner B, Taylor G, Schluchter M ,et al. Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000-2002. Pediatrics 2007;119:37-45. https://doi.org/10.1542/peds.2006-1416
  5. Valcamonico A, Accorsi P, Sanzeni C, Martelli P, La-Boria P. Cavazza A, et al. Mid- and long term outcome of extremely low birth weight (ELBW) infants: an analysis of prognostic factors. J Matern Fetal Neonatal Med. 2007;20:465-71. https://doi.org/10.1080/14767050701398413
  6. Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. N Engl J Med 2000;343:378-84. https://doi.org/10.1056/NEJM200008103430601
  7. Schmidt B, Asztalos EV, Roberts RS, Robertson CM, Sauve RS, Whitfield MF. Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months. JAMA 2003;289:1124-9. https://doi.org/10.1001/jama.289.9.1124
  8. Bassler D, Stoll BJ, Schmidt B, Asztalos EV, Roberts RS, Robertson CMT, et al. Using a count of neonatal morbidities to predict poor outcome in extremely low birth weight infants: added role of neonatal infection. Pediatrics 2009;123:313-8. https://doi.org/10.1542/peds.2008-0377
  9. Maiya PP, Nagashree S, Shaik MS. Role of score for neonatal acute physiology (SNAP) in predicting neonatal mortality. Indian J Pediatr 2001;68: 829-34. https://doi.org/10.1007/BF02762105
  10. Kaaresen PI, Dohlen G, Fundingsrud HP, Dahl LB. The use of CRIB (clinical risk index for babies) score in auditing the performance of one neonatal intensive care unit. Acta Paediatr 1998;87:195-200. https://doi.org/10.1111/j.1651-2227.1998.tb00975.x
  11. Parry G, Tucker J, Tarnow-Mordi W, UK Neonatal Staffing Study Collaborative Group. CRIB II: an update of the clinical risk index for babies score. Lancet 2003;361:1789-91. https://doi.org/10.1016/S0140-6736(03)13397-1
  12. Slater A, Shann F, Pearson G, PIM Study Group. PIM2: a revised version of the paediatric index of mortality. Intensive Care Med 2003;29:278-85.
  13. Stoll BJ, Adams-Chapman I. The high risk infants. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders Co, 2007:698-711.
  14. Bregman J, Farrell EE. Neurodevelopmental outcome in infants with bronchopulmonary dysplasia. Clin Perinatol 1992;19:673-94.
  15. Vohr BR, Wright LL, Dusick AM, Mele L, Verter J, Steichen JJ, et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the national institute of child health and human development neonatal research network, 1993-1994. Pediatrics 2000;105:1216-26. https://doi.org/10.1542/peds.105.6.1216
  16. Adams-Chapman I, Stoll BJ. Nervous system disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders Co, 2007:713-22.
  17. Olitsky SE, Hug D, Smith LP. Disorders of the retina and vitreous. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders Co, 2007:2598-605.
  18. Yeung MY. Postnatal growth, neurodevelopment and altered adiposity after preterm birth-from a clinical nutrition perspective. Acta Paediatr 2006;95:909-17 https://doi.org/10.1080/08035250600724507
  19. Yeung MY. Influence of early postnatal nutritional management on oxidative stress and antioxidant defence in extreme prematurity. Acta Paediatr 2006;95:153-63. https://doi.org/10.1080/08035250500301133
  20. Ehrenkranz RA, Walsh MC, Vohr BR, Jobe AH, Wright LL, Fanaroff AA, et al. Validation of the national institutes of health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005;116:1353-60. https://doi.org/10.1542/peds.2005-0249
  21. The Committee for the Classification of Retinopathy of Prematurity. An international classification of retinopathy of prematurity. Arch Ophthalmol 1984;102:1130-4. https://doi.org/10.1001/archopht.1984.01040030908011
  22. Kryter KD. Hearing loss from gun and railroad noise-relations with ISO standard 1999. J Acoust Soc Am 1991;90:3180-95. https://doi.org/10.1121/1.401427
  23. Hack M, Fanaroff AA. Outcomes of children of extremely low birthweight and gestational age in the 1990s. Semin Neonatol 2000;5:89-106. https://doi.org/10.1053/siny.1999.0001
  24. Tommiska V, Heinonen K, Lehtonen L, Renlund M, Saarela T, Tammela O, et al. No improvement in outcome of nationwide extremely low birth weight infant population between 1996-1997 and 1999-2000. Pediatrics 2007;119:29-36. https://doi.org/10.1542/peds.2006-1472

Cited by

  1. Definition and Outpatient Management of the Very Low-Birth-Weight Infant With Bronchopulmonary Dysplasia vol.29, pp.4, 2012, https://doi.org/10.1007/s12325-012-0015-y
  2. Parental concerns about their premature infants' health after discharge from the neonatal intensive care unit: a questionnaire survey for anticipated guidance in a neonatal follow-up clinic vol.55, pp.8, 2010, https://doi.org/10.3345/kjp.2012.55.8.272
  3. The pathophysiology of retinopathy of prematurity: an update of previous and recent knowledge vol.92, pp.1, 2014, https://doi.org/10.1111/aos.12049
  4. Prognosis of Very Preterm Infants with Severe Respiratory Distress Syndrome Receiving Mechanical Ventilation vol.193, pp.2, 2015, https://doi.org/10.1007/s00408-014-9683-5
  5. Prediction of Late Death or Disability at Age 5 Years Using a Count of 3 Neonatal Morbidities in Very Low Birth Weight Infants vol.167, pp.5, 2010, https://doi.org/10.1016/j.jpeds.2015.07.067
  6. The assessment of multifocal ERG responses in school-age children with history of prematurity vol.132, pp.1, 2016, https://doi.org/10.1007/s10633-016-9526-1
  7. Current perspective on retinopathy of prematurity vol.17, pp.5, 2010, https://doi.org/10.36290/ped.2016.064
  8. Incidence and risk factors for retinopathy of prematurity: a retrospective cohort study vol.4, pp.None, 2018, https://doi.org/10.1186/s40942-018-0125-z
  9. Model that predicted death or disabilities in premature infants was valid at seven years of age vol.108, pp.7, 2019, https://doi.org/10.1111/apa.14679
  10. Predicting the outcomes of preterm neonates beyond the neonatal intensive care unit: What are we missing? vol.89, pp.3, 2010, https://doi.org/10.1038/s41390-020-0968-5