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NEURODEVELOPMENTAL IMPAIRMENT: PREDICTORS OF ITS IMPACT ON THE FAMILIES OF EXTREMELY LOW BIRTH WEIGHT INFANTS AT 18 MONTHS.

ABSTRACT: Effects on a family of a child with chronic illness have been described. The Impact on Family Scale (IOF) was developed to measure these effects. The impact of extremely low birth weight (ELBW) infants with neurodevelopmental impairment on families is unknown. This study determined IOF scores for families of ELBW infants with increasing degree of impairment at 18 months and identified factors that increase vulnerability to impact. A total of 3,849 ELBW infant survivors born at the 16 centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 1993 and February 2001 were assessed at 18 to 22 months. Infants were divided into four groups by degree of impairment. IOF scores were analyzed by impairment group. Multivariate analyses assessed effects of impairment, social/demographic factors, unmet service needs, and resource utilization on the IOF. A total of 1,624 (42.2%) infants had moderate/severe impairment. Increasing severity of impairment was associated with higher IOF scores. Severity of impairment contributed 6% of variance to the IOF scores. Twenty-one percent of variance was contributed by additional medical needs, low socioeconomic status (SES), and lack of social support. Although increasing severity of impairment impacts families of ELBW infants, significantly more impact is contributed by additional medical needs, low SES, and lack of social support.

SUBMITTER: Stephens BE

PROVIDER: S-EPMC2749276 | biostudies-literature | 2008 Nov

REPOSITORIES: biostudies-literature

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NEURODEVELOPMENTAL IMPAIRMENT: PREDICTORS OF ITS IMPACT ON THE FAMILIES OF EXTREMELY LOW BIRTH WEIGHT INFANTS AT 18 MONTHS.

Stephens Bonnie E BE Bann Carla M CM Poole W Kenneth WK Vohr Betty R BR

Infant mental health journal 20081101 6

Effects on a family of a child with chronic illness have been described. The Impact on Family Scale (IOF) was developed to measure these effects. The impact of extremely low birth weight (ELBW) infants with neurodevelopmental impairment on families is unknown. This study determined IOF scores for families of ELBW infants with increasing degree of impairment at 18 months and identified factors that increase vulnerability to impact. A total of 3,849 ELBW infant survivors born at the 16 centers of ...[more]

PMID: 19779585

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Project description:ImportanceReduced death and neurodevelopmental impairment among infants is a goal of perinatal medicine.ObjectiveTo assess the association between surgery during the initial hospitalization and death or neurodevelopmental impairment of very low-birth-weight infants.Design, setting, and participantsA retrospective cohort analysis was conducted of patients enrolled in the National Institute of Child Health and Human Development Neonatal Research Network Generic Database from 1998 through 2009 and evaluated at 18 to 22 months' corrected age. Twenty-two academic neonatal intensive care units participated. Inclusion criteria were birth weight 401 to 1500 g, survival to 12 hours, and availability for follow-up. A total of 12 111 infants were included in analyses.ExposuresSurgical procedures; surgery also was classified by expected anesthesia type as major (general anesthesia) or minor (nongeneral anesthesia).Main outcomes and measuresMultivariable logistic regression analyses planned a priori were performed for the primary outcome of death or neurodevelopmental impairment and for the secondary outcome of neurodevelopmental impairment among survivors. Multivariable linear regression analyses were performed as planned for the adjusted mean scores of the Mental Developmental Index and Psychomotor Developmental Index of the Bayley Scales of Infant Development, Second Edition, for patients born before 2006.ResultsA total of 2186 infants underwent major surgery, 784 had minor surgery, and 9141 infants did not undergo surgery. The risk-adjusted odds ratio of death or neurodevelopmental impairment for all surgery patients compared with those who had no surgery was 1.29 (95% CI, 1.08-1.55). For patients who had major surgery compared with those who had no surgery, the risk-adjusted odds ratio of death or neurodevelopmental impairment was 1.52 (95% CI, 1.24-1.87). Patients classified as having minor surgery had no increased adjusted risk. Among survivors who had major surgery compared with those who had no surgery, the adjusted risk of neurodevelopmental impairment was greater and the adjusted mean Bayley scores were lower.Conclusions and relevanceMajor surgery in very low-birth-weight infants is independently associated with a greater than 50% increased risk of death or neurodevelopmental impairment and of neurodevelopmental impairment at 18 to 22 months' corrected age. The role of general anesthesia is implicated but remains unproven.

Project description:ObjectivePostnatal steroid use decreases lung inflammation but increases impairment. We hypothesized that increased dose is associated with increased neurodevelopmental impairment, lower postmenstrual age at exposure increases impairment, and risk of bronchopulmonary dysplasia modifies the effect of postnatal corticosteroid.MethodsSteroid dose and timing of exposure beyond 7 days was assessed among 2358 extremely low birth weight infants nested in a prospective trial, with 1667 (84%) survivors examined at 18 to 22 months' postmenstrual age. Logistic regression tested the relationship between impairment (Bayley Mental Developmental Index/Psychomotor Developmental Index of <70, disabling cerebral palsy, or sensory impairment), total dose (tertiles: <0.9, 0.9-1.9, and >/=1.9 mg/kg), and postmenstrual age at first dose. Separate logistic regression tested effect modification according to bronchopulmonary dysplasia severity (Romagnoli risk > 0.5 as high risk, n = 2336 (99%) for days of life 4-7).ResultsThree hundred sixty-six (16%) neonates were steroid-treated (94% dexamethasone). Treated neonates were smaller and less mature; 72% of those treated were at high risk for bronchopulmonary dysplasia. Exposure was associated with neurodevelopmental impairment/death. Impairment increased with higher dose; 71% dead or impaired at highest dose tertile. Each 1 mg/kg dose was associated with a 2.0-point reduction on the Mental Developmental Index and a 40% risk increase for disabling cerebral palsy. Older age did not mitigate the harm. Treatment after 33 weeks' postmenstrual age was associated with greatest harm despite not receiving the highest dose. The relationship between steroid exposure and impairment was modified by the bronchopulmonary dysplasia risk, with those at highest risk experiencing less harm.ConclusionsHigher steroid dose was associated with increased neurodevelopmental impairment. There is no "safe" window for steroid use in extremely low birth weight infants. Neonates with low bronchopulmonary dysplasia risk should not be exposed. A randomized trial of steroid use in infants at highest risk is warranted.

Dataset Information

NEURODEVELOPMENTAL IMPAIRMENT: PREDICTORS OF ITS IMPACT ON THE FAMILIES OF EXTREMELY LOW BIRTH WEIGHT INFANTS AT 18 MONTHS.

Publications

NEURODEVELOPMENTAL IMPAIRMENT: PREDICTORS OF ITS IMPACT ON THE FAMILIES OF EXTREMELY LOW BIRTH WEIGHT INFANTS AT 18 MONTHS.

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