Context Despite more than 2 decades of outcomes research after very preterm
birth, clinicians remain uncertain about the extent to which neonatal morbidities
predict poor long-term outcomes of extremely low-birth-weight (ELBW) infants.
Objective To determine the individual and combined prognostic effects of bronchopulmonary
dysplasia (BPD), ultrasonographic signs of brain injury, and severe retinopathy
of prematurity (ROP) on 18-month outcomes of ELBW infants.
Design Inception cohort assembled for the Trial of Indomethacin Prophylaxis
in Preterms (TIPP).
Setting and Participants A total of 910 infants with birth weights of 500 to 999 g who were admitted
to 1 of 32 neonatal intensive care units in Canada, the United States, Australia,
New Zealand, and Hong Kong between 1996 and 1998 and who survived to a postmenstrual
age of 36 weeks.
Main Outcome Measures Combined end point of death or survival to 18 months with 1 or more
of cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness.
Results Each of the neonatal morbidities was similarly and independently correlated
with a poor 18-month outcome. Odds ratios were 2.4 (95% confidence interval
[CI], 1.8-3.2) for BPD, 3.7 (95% CI, 2.6-5.3) for brain injury, and 3.1 (95%
CI, 1.9-5.0) for severe ROP. In children who were free of BPD, brain injury,
and severe ROP the rate of poor long-term outcomes was 18% (95% CI, 14%-22%).
Corresponding rates with any 1, any 2, and all 3 neonatal morbidities were
42% (95% CI, 37%-47%), 62% (95% CI, 53%-70%), and 88% (64%-99%), respectively.
Conclusion In ELBW infants who survive to a postmenstrual age of 36 weeks, a simple
count of 3 common neonatal morbidities strongly predicts the risk of later
death or neurosensory impairment.