Neurodevelopmental Outcome of Bronchopulmonary Dysplasia
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
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