Introduction
Pathogenesis
Clinical
Prevention
Management
Prognosis
Growth
Cardiovascular
Pulmonary
Neurodevelopmental
Mortality
References
Abbreviations
Other Lectures
|
|
Presurfactant studies of longterm developmental outcome in babies with BPD showed some disturbing, although ultimately more reassuring, findings. None of these studies showed an increase in cerebral palsy with BPD, but all showed more developmental delays, abnormal neurologic exams and worse Bayley scores in the babies with BPD. The more encouraging longterm finding was that these abnormalities often improved with age. In one study of babies born from 1975-1977, only 45% of BPD babies had a normal outcome at age 2, compared to 86% of non-BPD controls. However when this same group of babies was re-examined at age 11, the BPD survivors were not different from the premies without BPD.
All of these studies suffer the same limitations as many of the followup articles in the neonatology literature; namely, small sample size, varying BPD definitions, lack of control for known confounders (IVH, decreased bwt/GA), impact of parental education/SES rarely assessed. In addition, many of these older studies were done before use of head ultrasounds was routine, so information on IVH is lacking, making it difficult to assign blame to BPD alone for poor developmental outcomes. Very few post-surfactant (after 1992) followup studies have been reported.
In spite of these limitations, some general trends can be extracted from all of these studies:
- The greater the number of neonatal complications (IVH, ELBW, ROP, BPD, hearing loss), the less likely a normal outcome
- ALL babies with severe impairments at age 2 had multiple risk factors, but NOT ALL babies with multiple risk factors were severely impaired
- Because neurologic status may change over time, careful followup through school age is critical
- BPD babies have an increased risk of hearing loss and ROP
- BPD is an independent risk factor for poor motor outcomes, even after correction for ELBW
- The strongest predictors of longterm behavioral and school problems are parental education/SES and child-rearing by 2 parents
Return to top of page
|
