ABSTRACT
The neurocognitive outcome for infants with congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation (ECMO) is compared with that of neonates treated with ECMO for other diagnoses. The mean age at the time of the latest assessment (for the 51 survivors with adequate follow-up) was 31 months. The neurological outcomes did not differ significantly. However, the cognitive outcome for infants with congenital diaphragmatic hernia was significantly poorer than for those without it. This was particularly true if the infant with congenital diaphragmatic hernia was a boy and his mother had limited formal education.
Subject(s)
Child Development , Cognition , Extracorporeal Membrane Oxygenation , Hernia, Diaphragmatic/therapy , Psychomotor Performance , Child, Preschool , Developmental Disabilities/etiology , Developmental Disabilities/psychology , Educational Status , Female , Follow-Up Studies , Hernias, Diaphragmatic, Congenital , Humans , Infant , Male , Mothers , Neuropsychological Tests , Risk Factors , Sex Factors , Socioeconomic FactorsABSTRACT
Thirty-four infants who had a diagnosis of severe persistent pulmonary hypertension of the newborn at birth (alveolar-arterial oxygen difference greater than 600) were treated without paralysis or hyperventilation to induce alkalosis. All survived. Twenty-seven of these 34 eligible infants (79%) underwent neurologic, intelligence, and audiologic testing between 10 months and 6 years of age. Children who were younger than 1 year of age at the initial hearing test were retested after they reached 2 years of age. The average IQ was within the normal range (mean = 96.23). None had sensorineural hearing loss. Severe neurologic abnormalities were seen in 4 children, 3 of whom had been severely asphyxiated at birth (determined by biochemical criteria). Mild neurologic abnormalities were observed in 5 children. Two infants had bronchopulmonary dysplasia because they required supplemental oxygen for 29 and 66 days, respectively, and had abnormal chest roentgenograms; 1 patient takes intermittent doses of albuterol (Ventolin) and neither currently requires supplemental oxygen. This study of 27 infants with severe persistent pulmonary hypertension of the newborn suggests that conservative management without induced alkalosis or respiratory paralysis is accompanied by no sensorineural hearing loss and a good neurologic outcome.
Subject(s)
Child Development/physiology , Hearing/physiology , Persistent Fetal Circulation Syndrome/therapy , Apgar Score , Asphyxia Neonatorum/physiopathology , Carbon Dioxide/blood , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Intelligence/physiology , Male , Meconium , Oxygen/blood , Oxygen Inhalation Therapy , Persistent Fetal Circulation Syndrome/physiopathology , Positive-Pressure Respiration , Psychomotor Performance/physiology , Time Factors , Treatment OutcomeABSTRACT
This study examined the relationship of respiratory distress syndrome (RDS) and birth weight to cognitive development in 30 white, middle-class, low-birth-weight, preterm infants. Cognitive ability was assessed at 12, 36, and 48 months of age. No significant difference was found at any age between children who had and did not have RDS during the neonatal period. Children with birth weights of 1500 g or less were found to have lower scores than those with birth weights greater than 1500 g in the first year of life. However, the difference diminished with increasing age.
Subject(s)
Infant, Low Birth Weight , Infant, Premature , Intelligence , Respiratory Distress Syndrome, Newborn , Birth Weight , Child Development , Female , Follow-Up Studies , Gestational Age , Humans , Infant, Newborn , Longitudinal Studies , MaleABSTRACT
The obstetric and neonatal factors influencing survival and neurologic outcome are examined in 79 infants with birthweights of 700-1000 gm. The overall survival was 57%, with a normal neurologic examination at 1 year present in 73%. Factors that were significantly related to outcome were Apgar score at 5 minutes, birthweight, prenatal steroid administration, and lack of respiratory distress syndrome. Delivery by cesarean section did not improve survival or neurologic outcome. The implications of these results on the attitude toward management of the very-low-birthweight infant is discussed.
Subject(s)
Critical Care , Infant, Low Birth Weight , Prenatal Care , Adrenal Cortex Hormones/therapeutic use , Apgar Score , Delivery, Obstetric , Female , Fetal Organ Maturity/drug effects , Gestational Age , Humans , Infant Mortality , Infant, Newborn , Lung/embryology , Neurologic Examination , Pregnancy , Prognosis , Respiratory Distress Syndrome, Newborn/complicationsABSTRACT
A prospective study of 54 infants with birth weights of 1,000 gm or less was conducted over a period of two years. Of the 26 infants who survived, 24 weighed between 750 and 1,000 gm; two infants died after discharge and one was lost to follow-up, leaving 23 in whom serial observations were made over 18 months to 3 years of age. The incidence of neurologic deficit in these infants was 17% and of intellectual deficit, 13%. Of the four who were abnormal neurologically, two had spastic quadriparesis, one static encephalopathy, and one hydrocephalus secondary to intraventricular hemorrhage. The three with intellectual deficit had a developmental quotient less than 85. Of the perinatal factors examined, only birth asphyxia correlated significantly with both neonatal mortality and subsequent morbidity. Six (26%) of the surviving infants had mild, nonblinding retrolental fibroplasia; only one of them had a significant refractive error that required corrective lenses for vision. Sepsis was a significant contributor to neonatal mortality in ten of 28 infants who died, but was detected in only one survivor. Although the prognosis for the infant weighing 1,000 gm or less at delivery has improved significantly, there is promise for still further improvement by reducing perinatal asphyxia.