Neonatal correlates of adverse outcomes in very low-birthweight infants in the NICU Network

Background: The aim of the present study was to explore the relationships among neonatal morbidity, interventions and death or adverse neurodevelopmental outcomes in very low-birthweight (VLBW) infants.

Methods: Subjects were infants with birthweight ≤ 1500 g who were cared for in the tertiary neonatal intensive care units in Japan. Multiple logistic regression analysis was performed to examine the odds ratios (OR) and 95% confidence intervals (CI) of neonatal factors for death or cerebral palsy (CP) and death or developmental delay (developmental quotient <70 or delay judged by physicians) at 3 years of age after adjusting for biological and prenatal variables.

Results: Of the 3104 subjects, 257 died and 1826 were evaluated at 3 years of age. Cystic periventricular leukomalacia (PVL; OR, 23.9; 95%CI: 11.0-51.7), gastrointestinal perforation (OR, 8.5; 95%CI: 2.8-25.4), intraventricular hemorrhage (IVH) grade 3 or 4 (OR, 3.1; 95%CI: 1.3-7.2) and sepsis (OR, 2.6; 95%CI: 1.4-4.8) were neonatal factors significantly associated with an increased risk of death or CP. Significant correlates with death or developmental delay were cystic PVL (OR, 7.9; 95%CI: 3.7-16.8), gastrointestinal perforation (OR, 6.3; 95%CI: 1.9-20.8), sepsis (OR, 2.8; 95%CI: 1.6-4.8), IVH grade 3 or 4 (OR, 2.6; 95%CI: 1.2-5.7), chronic lung disease at 36 weeks of corrected gestational age (OR, 1.6; 95%CI: 1.1-2.4) and treatment for retinopathy of prematurity (ROP; OR, 1.5; 95%CI: 1.0-2.3).

Conclusion: Cystic PVL, gastrointestinal perforation, IVH and sepsis correlated with both death or CP and death or developmental delay in VLBW infants. Chronic lung disease at 36 weeks and treatment for ROP were associated with death or developmental delay, but not with death or CP.