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Clinical Trial
. 2009 Jan;123(1):313-8.
doi: 10.1542/peds.2008-0377.

Using a count of neonatal morbidities to predict poor outcome in extremely low birth weight infants: added role of neonatal infection

Dirk Bassler  1 , Barbara J Stoll, Barbara Schmidt, Elizabeth V Asztalos, Robin S Roberts, Charlene M T Robertson, Reg S Sauve; Trial of Indomethacin Prophylaxis in Preterms Investigators
Collaborators, Affiliations
Clinical Trial

Using a count of neonatal morbidities to predict poor outcome in extremely low birth weight infants: added role of neonatal infection

Dirk Bassler et al. Pediatrics. 2009 Jan.

Abstract

Objective: A count of 3 neonatal morbidities (bronchopulmonary dysplasia, brain injury, and severe retinopathy of prematurity) strongly predict the risk of death or neurosensory impairment in extremely low birth weight infants who survive to 36 weeks' postmenstrual age. Neonatal infection has also been linked with later impairment. We examined whether the addition of infection to the count of 3 neonatal morbidities further improves the prediction of poor outcome.

Methods: We studied 944 infants who participated in the Trial of Indomethacin Prophylaxis in Preterms and survived to 36 weeks' postmenstrual age. Culture-proven sepsis, meningitis, and stage II or III necrotizing enterocolitis were recorded prospectively. We investigated the incremental prognostic importance of neonatal infection by adding terms for the different types of infection to a logistic model that already contained terms for the count of bronchopulmonary dysplasia, brain injury, and severe retinopathy. Poor outcome at 18 months of age was death or survival with 1 or more of the following: cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness.

Results: There were 414 (44%) infants with at least 1 episode of infection or necrotizing enterocolitis. Meningitis and the presence of any type of infection added independent prognostic information to the morbidity-count model. The odds ratio associated with infection or necrotizing enterocolitis in this model was 50% smaller than the odds ratio associated with each count of the other 3 neonatal morbidities. Meningitis was rare and occurred in 22 (2.3%) of 944 infants.

Conclusions: In this cohort of extremely low birth weight infants who survived to 36 weeks' postmenstrual age, neonatal infection increased the risk of a late death or survival with neurosensory impairment. However, infection was a weaker predictor of poor outcome than bronchopulmonary dysplasia, brain injury, and severe retinopathy.

Trial registration: ClinicalTrials.gov NCT00009646.

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Figures

FIGURE 1
FIGURE 1
Probability of death after 36 weeks’ postmenstrual age or survival with neurodevelopmental impairment at 18 months by morbidity count, stratified according to the presence or absence of sepsis (A), meningitis (B), NEC (C), and infection or NEC (D). The dotted lines indicate the overall probability of a poor 18-month outcome (35%).
See this image and copyright information in PMC

References

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