A report on early neurodevelopmental outcomes in extremely low birth weight infants managed on early nasal continuous positive airway pressure

Abstract

At our institution a policy of early nasal continuous positive airway pressure (ENCPAP) in extremely low birth weight (ELBW) infants has been followed during the past 5 years. Routine intubation and surfactant administration is no longer our practice. The impact of this policy on infant outcomes is under investigation. This is a retrospective review of ELBW infants (< 1000 g) born at our institution between January 1998 and July 2002. Data on hearing deficits, visual impairment and Bayley scores at 3–6 months of corrected age were analyzed. Ninety-two ELBW infants were identified. Sixteen (17.4%) infants died and 14 (15.2%) ELBW were transferred to another institution. For the 62 survivors discharged home, mean gestational age was 26.4 ± 1.6 wks and birth weight was 797±129 g. The majority (67%) of these ELBW infants were managed with ENCPAP. Three (10.3%) infants had abnormalities on hearing evaluation. Three (4.8%) infants had retinopathy of prematurity requiring laser. Thirty infants were followed up developmentally. Four of these infants had normal neurodevelopmental evaluation at 6–8 weeks corrected age, and did not return for further follow-up. Twenty-six infants were followed at least through the three to six month visit. Six (23%) remained on high calorie formula with four (14%) infants requiring nasogastric tube feeding. Seven (25%) infants had Bayley mental developmental index < 70 (< 2 SD) and seven (25%) infants had Psychomotor Developmental Index < 70. Neurodevelopmental morbidity remains a concern for ELBW infants managed with ENCPAP. Although these results are subject to selection bias, the rates of neurodevelopmental morbidity are similar to those reported in the recent literature. (J Pediatr Neurol 2004; 2(3): 149–152).

Keywords

extremely low birth weight infants - neurodevelopmental outcome - continuous positive airway pressure