A LONGITUDINAL-STUDY OF DEVELOPMENTAL OUTCOME OF INFANTS WITH BRONCHOPULMONARY DYSPLASIA AND VERY-LOW-BIRTH-WEIGHT

Objective. Bronchopulmonary dysplasia (BPD) is now the leading cause o f lung disease in US infants. In a large regional cohort, we tested th e hypothesis that despite innovations in neonatal care, very low birth weight (VLBW) infants (<1500 g) with BPD had poorer developmental out comes than nonaffected infants during the first 3 years of life, and t hat BPD predicted poorer outcome beyond the effects of other risk fact ors. Methods. Three groups of infants (122 with BPD, 84 VLBW without B PD, and 123 full-term) were followed longitudinally to 3 years of age with the Bayley Scales of Mental and Motor Development. Comparison gro ups of VLBW infants without BPD and full-term infants did not differ i n sex, race, or socioeconomic status. Statistical analyses included hi erarchical and stepwise multiple regression. Results. Infants with BPD performed more poorly at all ages. By 3 years, cognitive and/or motor development was in the range of retardation (<70 standard score) for 21% to 22% of infants with BPD. In multiple regression analyses contro lling for socioeconomic and neonatal risk conditions, BPD had an indep endent negative effect on motor outcome at 3 years. Neurologic risk, a summary measure of neurologic problems other than intraventricular he morrhage, and the presence of BPD independently predicted motor delay. By 3 years, social class, race, and neurologic risk predicted mental outcome, suggesting that the specific effects of BPD are primarily on the motor domain. Conclusions. In VLBW infants, BPD predicts poorer mo tor outcome at 3 years, after control for other risks. Cohorts of infa nts with BPD also had higher rates of mental retardation, associated w ith greater neurologic and social risk. These findings underscore the need for intensive prevention and habilitation efforts for this growin g group of VLBW survivors, as well as investigation into the potential role of BPD in the higher rates of learning disabilities in VLBW coho rts at school age.