Neurodevelopmental outcome in infants with bronchopulmonary dysplasia

Abstract

It appears that the survivor of BPD is at risk for neurodevelopmental compromise but not necessarily to any greater extent than are prematurely born infants in general. What appears to be true is that as the neonatal course becomes more complicated, and the birth weight drops, the risk increases. If a BPD survivor sustains a moderate to severe IVH, particularly if accompanied by periventricular leukomalacia, the risk of significant handicap increases substantially. Effects of socioeconomic status (SES) are also important, and become more evident over time with a direct correlation between SES and outcome. Maximizing the environmental conditions while in the special care nursery, and reducing stress on the infant during the illness, may help to reduce risk of a compromised developmental outcome in the survivors. Careful monitoring of oxygen saturation postdischarge may similarly have a positive effect on outcome. Although direct comparability among studies is not possible, it appears that most reports suggest about half the survivors are free of any handicapping condition at follow-up, and about half are either moderately or severely impaired. Cerebral palsy is the most frequently reported handicapping condition. Since the presence or absence of significant IVH is not consistently reported across studies, it is not possible to know if infants who subsequently develop CP sustained a bleed, in addition to BPD, in the neonatal period. In studies in which this is more carefully delineated, that appears to be the case. In studies in which infants with significant hemorrhage were either excluded or dropped out, no survivors with cerebral palsy are reported. Approximately 4% of survivors across all studies reviewed were blind as a result of severe retinopathy of prematurity. Several studies excluded infants who developed significant ROP from their follow-up, so this percentage may be an underestimate of the actual incidence across all BPD survivors. With a greater number of gestationally younger infants surviving, this is one area of handicap that may increase in the years to come. Not all studies report on the presence of sensorineural hearing loss in survivors, but there is the suggestion this may occur perhaps in up to 4% of survivors. This is an area that future research should address. For infants who fall in the moderately handicapped category, typically defined as more than one standard deviation below the mean on a standardized developmental examination, that rating may change over time in either direction.(ABSTRACT TRUNCATED AT 400 WORDS)