Elsevier

The Journal of Pediatrics

Volume 167, Issue 5, November 2015, Pages 982-986.e2
The Journal of Pediatrics

Original Article
Prediction of Late Death or Disability at Age 5 Years Using a Count of 3 Neonatal Morbidities in Very Low Birth Weight Infants

https://doi.org/10.1016/j.jpeds.2015.07.067Get rights and content

Objective

To evaluate bronchopulmonary dysplasia (BPD), serious brain injury, and severe retinopathy of prematurity (ROP) as predictors of poor long-term outcome in very low birth weight infants.

Study design

We examined the associations between counts of the 3 morbidities and long-term outcomes in 1514 of 1791 (85%) infants with birth weights of 500-1250 g who were enrolled in the Caffeine for Apnea of Prematurity trial from October 1999, to October 2004, had complete morbidity data, and were alive at 36 weeks postmenstrual age (PMA). BPD was defined as use of supplemental oxygen at 36 weeks PMA. Serious brain injury on cranial ultrasound included grade 3 and 4 hemorrhage, cystic periventricular leucomalacia, porencephalic cysts, or ventriculomegaly of any cause. Poor long-term outcome was death after 36 weeks PMA or survival to 5 years with 1 or more of the following disabilities: motor impairment, cognitive impairment, behavior problems, poor general health, deafness, and blindness.

Results

BPD, serious brain injury, and severe ROP occurred in 43%, 13%, and 6% of the infants, respectively. Each of the 3 morbidities was similarly and independently correlated with poor 5-year outcome. Rates of death or disability (95% CI) in children with none, any 1, any 2, and all 3 morbidities were 11.2% (9.0%-13.7%), 22.9% (19.6%-26.5%), 43.9% (35.5%-52.6%), and 61.5% (40.6%-79.8%), respectively.

Conclusions

In very low birth weight infants who survive to 36 weeks PMA, a count of BPD, serious brain injury, and severe ROP predicts the risk of a late death or survival with disability at 5 years.

Section snippets

Methods

Infants with birth weights of 500 to 1250 g were enrolled in the international CAP trial between 1999 and 2004 and followed to a corrected age of 5 years.14, 15, 16 The research ethics boards of all participating clinical centers approved the initial trial protocol and the additional 5-year follow-up. Written informed consent was obtained from a parent or guardian of each infant prior to enrollment and again before the assessments at 5 years. Only infants who survived to 36 weeks PMA were

Results

A total of 2006 infants with birth weights of 500-1250 g were enrolled in the original CAP trial. Four of 35 clinical centers did not participate in the 5-year follow-up. The remaining 31 centers had enrolled 1932 infants, of whom 1853 survived to 36 weeks PMA. All 3 neonatal morbidities—BPD, brain injury, and severe ROP—were known for 1791 CAP trial participants, of whom 1514 children had adequate data for the analysis of the composite outcome of death or disability at 5 years. The

Discussion

This ancillary analysis of CAP trial data for infants with birth weights of 500-1250 g confirmed the independent prognostic effect of BPD, serious brain injury, and severe ROP we previously observed in the Trial of Indomethacin Prophylaxis in Preterms cohort.11 Counting whether infants developed none, any 1, any 2, or all 3 of these neonatal morbidities strongly predicted a late death after 36 weeks PMA or disability at a corrected age of 5 years. Each additional morbidity multiplies the odds

References (22)

  • B. Schmidt et al.

    Association between severe retinopathy of prematurity and nonvisual disabilities at age 5 years

    JAMA

    (2014)
  • Cited by (162)

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    Funded by the Canadian Institutes of Health Research (MCT-13288). The authors declare no conflicts of interest.

    List of CAP Trial Investigators is available at www.jpeds.com (Appendix).

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