European Journal of Pediatrics

, Volume 167, Issue 1, pp 87–95 | Cite as

Outcome of extremely low birth weight survivors at school age: the influence of perinatal parameters on neurodevelopment

  • Achim-Peter Neubauer
  • Wolfgang Voss
  • Evelyn Kattner
Original Paper

Abstract

Extremely low birth weight (ELBW) is associated with impaired neurodevelopmental outcome in infancy. Information on the long-term cognitive and neurological consequences of ELBW is scarce. We aimed to identify the perinatal and neonatal factors of ELBW infants associated with adverse cognitive and neurological outcome at school age. A regional cohort of 135 ELBW infants born between 1993 and 1998 was prospectively evaluated at 3, 6, 12, and 18 months postmenstrual age and at yearly intervals up to age 10 years. The comprehensive follow-up programme for high-risk infants included neurological examinations and psychometric evaluations. According to the overall results of these tests, children were classified as either being normal or having minor or major impairment. At a mean age of 8.4 (SD: 1.6) years, 43% of children had survived without any impairment. Minor impairment was diagnosed in 39% and major impairment in 18% of assessed children. The proportion of disabled school children rose with decreasing gestational age. The following neonatal complications were significant risk factors for developing major or minor impairment at school age: an increase in head circumference <6 mm per week (OR 4.0, 95% CI: 1.1–14.8), parenteral nutrition ≥6 weeks (OR 2.5, 95% CI: 1.1–6.0), and mechanical ventilation >14 days (OR 2.3, 95% CI: 1.0–5.1). High-grade intraventricular haemorrhage (IVH) and/or PVL (OR 13.3, 95% CI: 4.0–44.9), neonatal seizures (OR 5.2, 95% CI: 1.2–22.4) and bowel perforation, and/or necrotizing enterocolitis (OR 4.4, 95% CI: 1.1–17.0) were significant risk factors for developing major impairment. In spite of the relatively large proportion of normal children, ELBW remains an important risk factor for neurodevelopmental impairment at school age. Thus, measures to prevent complications such as necrotizing enterocolitis, cerebral haemorrhage, and undernutrition remain important goals for neonatal intensive care.

Keywords

Extremely low birth weight infant Child development/complications Developmental disabilities Follow-up studies 

Abbreviations

BPD

bronchopulmonary dysplasia

CP

cerebral palsy

CTG

cardiotocography

CRIB

clinical risk index for babies

ED

expected date of delivery

ELBW

extremely low birth weight

IVH

peri- and intraventricular haemorrhage

NEC

necrotizing enterocolitis

NICU

neonatal intensive care unit

OR

odds ratio

PDA

patent ductus arteriosus

PVL

periventricular leukomalacia

RDS

respiratory distress syndrome

Notes

Acknowledgements

We thank the staff of our high-risk infant follow-up programme for the comprehensive documenation of parameters.

We thank Gratiana Steinkamp, Hannover, for providing medical writing services.

References

  1. 1.
    Ambalavanan N, Nelson KG, Alexander G, Johnson SE, Biasini F, Carlo WA (2000) Prediction of neurologic morbidity in extremely low birth weight infants. J Perinatol 20:496–503PubMedCrossRefGoogle Scholar
  2. 2.
    Anderson P, Doyle LW, Victorian Infant Collaborative Study Group (2003) Neurobehavioral outcomes of school-age children born extremely low birth weight or very preterm in the 1990s. JAMA 289:3264–3272PubMedCrossRefGoogle Scholar
  3. 3.
    Berseth CL, Bisquera JA, Paje VU (2003) Prolonging small feeding volumes early in life decreases the incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics 111:529–534PubMedCrossRefGoogle Scholar
  4. 4.
    Blitz RK, Wachtel RC, Blackmon L, Berenson-Howard J (1997) Neurodevelopmental outcome of extremely low birth weight infants in Maryland. Md Med J 46:18–24PubMedGoogle Scholar
  5. 5.
    Bowen JR, Starte DR, Arnold JD, Simmons JL, Ma PJ, Leslie GI (1993) Extremely low birthweight infants at 3 years: a developmental profile. J Paediatr Child Health 29:276–281PubMedGoogle Scholar
  6. 6.
    Cooke RWI, Foulder-Hughes L (2003) Growth impairment in the very preterm and cognitive and motor performance at 7 years. Arch Dis Child 88:482–487PubMedCrossRefGoogle Scholar
  7. 7.
    Cummings JJ, D’Eugenio DB, Gross SJ (1989) A controlled trial of dexamethasone in preterm infants at high risk for bronchopulmonary dysplasia. N Engl J Med 320:1505–1510PubMedCrossRefGoogle Scholar
  8. 8.
    D’Angio CT, Sinkin RA, Stevens TP, Landfish NK, Merzbach JL, Ryan RM, Phelps DL, Palumbo DR, Myers GJ (2002) Longitudinal, 15-year follow-up of children born at less than 29 weeks’ gestation after introduction of surfactant therapy into a region: neurologic, cognitive, and educational outcomes. Pediatrics 110:1094–1102PubMedCrossRefGoogle Scholar
  9. 9.
    De Vries LS, Eken P, Dubowitz LMS (1992) The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res 49:1–6PubMedCrossRefGoogle Scholar
  10. 10.
    Doyle LW, Anderson PJ; Victorian Infant Collaborative Study group (2005) Improved neurosensory outcome at 8 years of age of extremely low birthweight children born in Victoria over 3 distinct eras. Arch Dis Child Fetal Neonatal Ed 90:484–488CrossRefGoogle Scholar
  11. 11.
    Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK (2006) Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 117:1253–1261PubMedCrossRefGoogle Scholar
  12. 12.
    Escobar GJ, Littenberg B, Petitti DB (1991) Outcome among surviving very low birthweight infants: a meta-analysis. Arch Dis Child 66:204–211PubMedGoogle Scholar
  13. 13.
    Evans RA, Thureen P (2001) Early feeding strategies in preterm and critically ill neonates. Neonatal Netw 20:7–18PubMedGoogle Scholar
  14. 14.
    Farooqi A, Hagglof B, Sedin G, Gothefors L, Serenius F (2006) Chronic conditions, functional limitations, and special health care needs in 10- to 12-year-old children born at 23 to 25 weeks’ gestation in the 1990s: a Swedish national prospective follow-up study. Pediatrics 118:e1466–e1477PubMedCrossRefGoogle Scholar
  15. 15.
    Flidel-Rimon O, Friedman S, Lev E, Juster-Reicher A, Amitay M, Shinwell ES (2004) Early enteral feeding and nosocomial sepsis in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 89:F289–F292PubMedCrossRefGoogle Scholar
  16. 16.
    Garcia-Alix A, Saenz-de Pipaon M, Martinez M, Salas-Hernandez S, Quero J (2004) [Ability of neonatal head circumference to predict long-term neurodevelopmental outcome] TT-Utilidad del perimetro cefalico en el recien nacido para anticipar problemas en el neurodesarrollo. Rev Neurol 39:548–554PubMedGoogle Scholar
  17. 17.
    Hack M, Friedman H, Fanaroff AA (1996) Outcomes of extremely low birth weight infants. Pediatrics 98:931–937PubMedGoogle Scholar
  18. 18.
    Hack M, Taylor HG, Klein N, Eiben R, Schatschneider C, Mercuri-Minich N (1994) School-age outcomes in children with birth weights under 750 g. N Engl J Med 331:753–759PubMedCrossRefGoogle Scholar
  19. 19.
    Hack M, Taylor HG, Drotar D, Schluchter M, Cartar L, Andreias L, Wilson-Costello D, Klein N (2005) Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s. JAMA 294:318–325PubMedCrossRefGoogle Scholar
  20. 20.
    Hack M, Wilson-Costello D, Friedman H, Taylor GH, Schluchter M, Fanaroff AA (2000) Neurodevelopment and predictors of outcomes of children with birth weights of less than 1,000 g: 1992–1995. Arch Pediatr Adolesc Med 154:725–731PubMedGoogle Scholar
  21. 21.
    Halliday HL (2001) The effect of postnatal steroids on growth and development. J Perinat Med 29:281–285PubMedCrossRefGoogle Scholar
  22. 22.
    Hay WW Jr (1994) Nutritional requirements of extremely low birthweight infants. Acta Paediatr Suppl 402:94–99PubMedGoogle Scholar
  23. 23.
    Hintz SR, Kendrick DE, Stoll BJ, Vohr BR, Fanaroff AA, Donovan EF, Poole WK, Blakely ML, Wright L, Higgins R (2005) Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis. Pediatrics 115:696–703PubMedCrossRefGoogle Scholar
  24. 24.
    Jobe AH, Bancalari E (2001) Bronchopulmonary dysplasia. Am J Respir Crit Care Med 163:1723–1729PubMedGoogle Scholar
  25. 25.
    Lee KS, Kim BI, Khoshnood B, Hsieh HL, Chen TJ, Herschel M, Mittendorf R (1995) Outcome of very low birth weight infants in industrialized countries: 1947–1987. Am J Epidemiol 141:1188–1193PubMedGoogle Scholar
  26. 26.
    Marlow N, Wolke D, Bracewell MA, Samara M (2005) Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 352:9–19PubMedCrossRefGoogle Scholar
  27. 27.
    Melchers P, Preuss U (1991) K-ABC: Kaufman Assessment Battery for children. Deutschsprachige Fassung. Swets & Zeitlinger, FrankfurtGoogle Scholar
  28. 28.
    Mikkola K, Ritari N, Tommiska V, Salokorpi T, Lehtonen L, Tammela O, Paakkonen L, Olsen P, Korkman M, Fellman V (2005) Neurodevelopmental outcome at 5 years of age of a national cohort of extremely low birth weight infants who were born in 1996–1997. Pediatrics 116:1391–1400PubMedCrossRefGoogle Scholar
  29. 29.
    Papile LA, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 92:529–534PubMedCrossRefGoogle Scholar
  30. 30.
    Patole SK, de Klerk N (2005) Impact of standardised feeding regimens on incidence of neonatal necrotising enterocolitis: a systematic review and meta-analysis of observational studies. Arch Dis Child Fetal Neonatal Ed 90:F147–F151PubMedCrossRefGoogle Scholar
  31. 31.
    Patra K, Wilson-Costello D, Taylor HG, Mercuri-Minich N, Hack M (2006) Grades I-II intraventricular hemorrhage in extremely low birth weight infants: effects on neurodevelopment. J Pediatr 149:169–173PubMedCrossRefGoogle Scholar
  32. 32.
    Robertson CM, Hrynchyshyn GJ, Etches PC, Pain KS (1992) Population-based study of the incidence, complexity, and severity of neurologic disability among survivors weighing 500 through 1,250 grams at birth: a comparison of two birth cohorts. Pediatrics 90:750–755PubMedGoogle Scholar
  33. 33.
    Salhab WA, Perlman JM, Silver L, Sue BR (2004) Necrotizing enterocolitis and neurodevelopmental outcome in extremely low birth weight infants <1,000 g. J Perinatol 24:534–540PubMedCrossRefGoogle Scholar
  34. 34.
    Sherlock RL, Anderson PJ, Doyle LW; Victorian Infant Collaborative Study Group (2005) Neurodevelopmental sequelae of intraventricular haemorrhage at 8 years of age in a regional cohort of ELBW/very preterm infants. Early Hum Dev 81:909–916PubMedCrossRefGoogle Scholar
  35. 35.
    Sonntag J, Grimmer I, Scholz T, Metze B, Wit J, Obladen M (2000) Growth and neurodevelopmental outcome of very low birthweight infants with necrotizing enterocolitis. Acta Paediatr 89:528–532PubMedCrossRefGoogle Scholar
  36. 36.
    Tellegen PJ, Winkel M, Wijnberg-Williams BJ (1996) Snijders-Oomen Non-verbaler Intelligenztest (SON-R 2 1/2–7). Deutschsprachige Fassung. Swets & Zeitlinger, FrankfurtGoogle Scholar
  37. 37.
    Tewes U, Rossmann R, Schallberger U (1999) Der Hamburg-Wechsler-Intelligenztest für Kinder (HAWIK-III). Huber-Verlag, BernGoogle Scholar
  38. 38.
    The Victorian Infant Collaborative Study Group (1995) Neurosensory outcome at 5 years and extremely low birthweight. Arch Dis Child Fetal Neonatal Ed 73:F143–F146Google Scholar
  39. 39.
    The Victorian Infant Collaborative Study Group (1997) Improved outcome into the 1990s for infants weighing 500–999 g at birth. Arch Dis Child Fetal Neonatal Ed 77:F91–F94Google Scholar
  40. 40.
    Touwen BCL (1979) Examination of the child with minor neurological dysfunction. Clin Dev Med 58:8–107Google Scholar
  41. 41.
    Troche B, Harvey-Wilkes K, Engle WD, Nielsen HC, Frantz ID 3rd, Mitchell ML, Hermos RJ (1995) Early minimal feedings promote growth in critically ill premature infants. Biol Neonate 67:172–181PubMedCrossRefGoogle Scholar
  42. 42.
    Vohr BR, Wright LL, Poole WK, McDonald SA (2005) Neurodevelopmental outcomes of extremely low birth weight infants <32 weeks’ gestation between 1993 and 1998. Pediatrics 16:635–643CrossRefGoogle Scholar
  43. 43.
    Voigt M, Schneider KT, Jaehrig K (1996) [Analysis of a 1992 birth sample in Germany. 1: new percentile values of the body weight of newborn infants] TT-Analyse des Geburtengutes des Jahrgangs 1992 der Bundesrepublik Deutschland. Teil 1: Neue Perzentilwerte für die Körpermasse von Neugeborenen. Geburtshilfe Frauenheilkd 56:550–558PubMedCrossRefGoogle Scholar
  44. 44.
    Voss W, Neubauer AP, Wachtendorf M, Verhey JF, Kattner E (2007) Neurodevelopmental outcome in extremely low birth weight infants-What is the minimum age for reliable developmental prognosis? Acta Paediatr: in pressGoogle Scholar
  45. 45.
    Walsh MC, Kliegman RM, Hack M (1989) Severity of necrotizing enterocolitis: influence on outcome at 2 years of age. Pediatrics 84:808–814PubMedGoogle Scholar
  46. 46.
    Wilson-Costello D, Friedman H, Minich N, Fanaroff AA, Hack M (2005) Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants in the 1990s. Pediatrics 115:997–1003PubMedCrossRefGoogle Scholar
  47. 47.
    Wilson-Costello D, Friedman H, Minich N, Siner B, Taylor G, Schluchter M, Hack M (2007) Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000–2002. Pediatrics 119:37–45PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Achim-Peter Neubauer
    • 1
  • Wolfgang Voss
    • 2
  • Evelyn Kattner
    • 3
  1. 1.Kinderkrankenhaus auf der BultHannoverGermany
  2. 2.Sozialpädiatrisches ZentrumHannoverGermany
  3. 3.Kinderkrankenhaus auf der BultHannoverGermany

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