Elsevier

Seminars in Perinatology

Volume 30, Issue 4, August 2006, Pages 227-232
Seminars in Perinatology

Neurodevelopmental Outcome of Bronchopulmonary Dysplasia

https://doi.org/10.1053/j.semperi.2006.05.010Get rights and content

Children born very preterm are vulnerable for long-term cognitive, educational, and behavioral impairments; bronchopulmonary dysplasia (BPD) is an additional risk factor which exacerbates these problems. As a population, children with BPD exhibit low average IQ, academic difficulties, delayed speech and language development, visual–motor integration impairments, and behavior problems. Neuropsychological studies are sparse, but there is some evidence that children with BPD also display attention problems, memory and learning deficits, and executive dysfunction. BPD does not appear to be associated with a specific neuropsychological impairment but rather a global impairment.

Section snippets

Neurosensory Problems

Cerebral palsy (CP) affects approximately 10% of surviving children born <1000 g, a rate which has been stable over several decades since the late 1970s.3 Similar rates are reported for infants <28 weeks’ gestation,4 but are clearly higher in those <27 weeks (18-20%) than in those 27 to 32 weeks (11-12%),19 and even higher at 22% in those <25 weeks’ gestation.20 CP rates are usually higher in children with BPD. In one study of infants of BW <1500 g, 15% of survivors of BPD, defined as oxygen

General Cognitive Functioning

Outcome studies clearly demonstrate that very preterm and VLBW children score lower on tests of general cognitive functioning [ie, general intelligence (IQ)] than full-term peers.28, 29, 30, 31, 32, 33 There is also evidence that IQ in the preterm population declines with decreasing BW,29, 30, 33 and that developmental delay and general cognitive deficits are more common in preterm children who experience neonatal complications such as BPD.18, 34, 35

Tests of early development such as the Bayley

Psychological Problems

In addition to cognitive and educational problems, preterm children have a higher incidence of psychological problems than full-term children.29, 62, 63 Preterm children who experience medical complications, such as BPD, tend to exhibit more behavioral problems than peers without complications.41, 42 In many cases, behavioral problems exhibited by preterm children may be a response to learning, communication, and social difficulties; however, higher than expected rates of specific developmental

Pathways to Neuropsychological Impairment

Disrupted brain development is one explanation for the poorer outcome in children with BPD. Children with BPD are generally sicker and tend to have more feeding problems than preterm children without BPD,6 and are more likely to grow poorly and have smaller head circumferences.11, 12, 24 Brain development is extremely active during the third trimester when these children are fighting for survival. For example, during this period, cortical gray matter volumes increase fourfold and white matter

Conclusions

Although there has been substantial research exploring the relationship between BPD and later development, most of the studies have been cross-sectional and employed general outcome measures such as IQ. To date, few studies have adopted a neuropsychological approach, and as such there is limited information on how BPD affects specific cognitive domains. Furthermore, given that BPD often occurs in conjunction with other serious medical complications, the independent affect of BPD is difficult to

References (82)

  • W.H. Northway et al.

    Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia

    N Engl J Med

    (1967)
  • L.W. Doyle

    Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades. I. Effectiveness

    Pediatrics

    (2004)
  • L.W. Doyle

    Respiratory function at age 8-9 years in extremely low birthweight/very preterm children born in Victoria in 1991-92

    Pediatr Pulmonol

    (2006)
  • M.D. Skidmore et al.

    Increased risk of cerebral palsy among very low-birthweight infants with chronic lung disease

    Dev Med Child Neurol

    (1990)
  • M. Garg et al.

    Clinically unsuspected hypoxia during sleep and feeding in infants with bronchopulmonary dysplasia

    Pediatrics

    (1988)
  • J. Volpe

    Neurology of the Newborn

    (2001)
  • P.W. Fuller et al.

    A proposed neuropathological basis for learning disabilities in children born prematurely

    Dev Med Child Neurol

    (1983)
  • C.A. Chiriboga et al.

    Factors associated with microcephaly at school age in a very-low-birthweight population

    Dev Med Child Neurol

    (2003)
  • T.M. O’Shea et al.

    Outcome at 4 to 5 years of age in children recovered from neonatal chronic lung disease

    Dev Med Child Neurol

    (1996)
  • M.C. Sullivan et al.

    Perinatal morbidity, mild motor delay, and later school outcomes

    Dev Med Child Neurol

    (2003)
  • L.W. Doyle et al.

    Impact of postnatal systemic corticosteroids on mortality and cerebral palsy in preterm infantseffect modification by risk of chronic lung disease

    Pediatrics

    (2005)
  • A.H. Jobe et al.

    Bronchopulmonary dysplasia

    Am J Respir Crit Care Med

    (2001)
  • C.A. Hughes et al.

    Cognitive performance at school age of very low birth weight infants with bronchopulmonary dysplasia

    J Dev Behav Pediatr

    (1999)
  • E.J. Short et al.

    Cognitive and academic consequences of bronchopulmonary dysplasia and very low birth weight8-year-old outcomes

    Pediatrics

    (2003)
  • B.R. Vohr et al.

    Neurodevelopmental outcomes of extremely low birth weight infants <32 weeks’ gestation between 1993 and 1998

    Pediatrics

    (2005)
  • S.R. Hintz et al.

    Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis

    Pediatrics

    (2005)
  • J.M. Perlman et al.

    Movement disorder of premature infants with severe bronchopulmonary dysplasiaa new syndrome

    Pediatrics

    (1989)
  • L. Holsti et al.

    Developmental coordination disorder in extremely low birth weight children at nine years

    J Dev Behav Pediatr

    (2002)
  • B.R. Vohr et al.

    Neurodevelopmental and medical status of low-birthweight survivors of bronchopulmonary dysplasia at 10 to 12 years of age

    Dev Med Child Neurol

    (1991)
  • F.G. McGinnity et al.

    Perinatal predictors of ocular morbidity in school children who were very low birthweight

    Paediatr Perinat Epidemiol

    (1993)
  • R.J. Adams et al.

    Long-term visual pathology in children with significant perinatal complications

    Dev Med Child Neurol

    (2005)
  • P.H. Gray et al.

    Conductive hearing loss in preterm infants with bronchopulmonary dysplasia

    J Paediatr Child Health

    (2001)
  • S. Saigal et al.

    School-age outcomes in children who were extremely low birth weight from four international population-based cohorts

    Pediatrics

    (2003)
  • P. Anderson et al.

    Neurobehavioral outcomes of school-age children born extremely low birth weight or very preterm in the 1990s

    JAMA

    (2003)
  • A. Bhutta et al.

    Cognitive and behavioral outcomes of school-aged children who were born pretermA meta-analysis

    JAMA

    (2002)
  • N. Marlow et al.

    Neurologic and developmental disability at six years of age after extremely preterm birth

    N Eng J Med

    (2005)
  • D. Wolke et al.

    Cognitive status, language attainment, and prereading skills of 6-year-old very preterm children and their peersthe Bavarian Longitudinal Study

    Dev Med Child Neurol

    (1999)
  • H.G. Taylor et al.

    Long-term neuropsychological outcomes of very low birth weightassociations with early risks for periventricular brain insults

    J Int Neuropsychol Soc

    (2004)
  • B.R. Vohr et al.

    School-age outcomes of very low birth weight infants in the Indomethacin Intraventricular Hemorrhage Prevention Trial

    Pediatrics

    (2003)
  • H. Koller et al.

    Patterns of cognitive development in very low birth weight children during the first six years of life

    Pediatrics

    (1997)
  • N. Bayley
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