Stability of neuromotor outcomes at 18 and 30 months of age after extremely low birth weight status
Myriam Peralta-Carcelen, Marybeth Moses, Ira Adams-Chapman, Marie Gantz, Betty R Vohr, NICHD Neonatal Research Network, National Institutes of Health, Alan Jobe, William Oh, Betty R Vohr, Angelita Hensman, Lucy Noel, Barbara Alksininis, Martha R Leonard, Rachel A Vogt, Teresa M Leach, Victoria E Watson, Avroy A Fanaroff, Deanne Wilson-Costello, Nancy S Newman, Bonnie S Siner, Harriet G Friedman, Barbara J Stoll, Ira Adams-Chapman, Ellen Hale, Maureen Mulligan LaRossa, Sheena Carter, James A Lemons, Anna M Dusick, Carolyn Lytle, Darlene Kardatzke, Marilyn Bull, Greg Eaken, Lon G Bohnke, Leslie Richard, Diana D Appel, Dianne Herron, Lucy Miller, Leslie Dawn Wilson, Linda L Wright, Elizabeth M McClure, W Kenneth Poole, Betty Hastings, David K Stevenson, Susan R Hintz, Barry E Fleisher, M Bethany Ball, Carol G Kuelper, Julie C Lee, Joan M Baran, Lori E Bond, Nicholas St John, Renee P Pyle, Waldemar A Carlo, Myriam Peralta-Carcelen, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Fred J Biasini, Kirstin J Bailey, Richard V Rector, Stephanie A Chopko, Neil N Finer, Yvonne E Vaucher, Maynard R Rasmussen, Kathy Arnell, Clarence Demetrio, Martha G Fuller, Chris Henderson, Donna Posin, Edward F Donovan, Jean Steichen, Barb Alexander, Cathy Grisby, Marcia Mersmann, Holly Mincey, Jody Shively, Teresa L Gratton, Shahnaz Duara, Charles R Bauer, Ruth Everett, Alexis N Diaz, Elaine O Mathews, Kasey Hamlin-Smith, Lisa Jean-Gilles, Maria Calejo, Silvia M Frade, Silvia Hiriart-Fajardo, Yamiley Gideon, Sheldon B Korones, Henrietta S Bada, Tina Hudson, Kim Yolton, Marilyn Williams, Abbot R Laptook, Sue Broyles, Susie Madison, Jackie F Hickman, Sally Adams, Linda Madden, Elizabeth Heyne, Cristin Dooley, Seetha Shankaran, Yvette Johnson, Rebecca Bara, Geraldine Muran, Deborah Kennedy, Laura Goldston, Richard A Ehrenkranz, Patricia Gettner, Monica Konstantino, Elaine Romano, Nancy Close, Walter Gilliam, Myriam Peralta-Carcelen, Marybeth Moses, Ira Adams-Chapman, Marie Gantz, Betty R Vohr, NICHD Neonatal Research Network, National Institutes of Health, Alan Jobe, William Oh, Betty R Vohr, Angelita Hensman, Lucy Noel, Barbara Alksininis, Martha R Leonard, Rachel A Vogt, Teresa M Leach, Victoria E Watson, Avroy A Fanaroff, Deanne Wilson-Costello, Nancy S Newman, Bonnie S Siner, Harriet G Friedman, Barbara J Stoll, Ira Adams-Chapman, Ellen Hale, Maureen Mulligan LaRossa, Sheena Carter, James A Lemons, Anna M Dusick, Carolyn Lytle, Darlene Kardatzke, Marilyn Bull, Greg Eaken, Lon G Bohnke, Leslie Richard, Diana D Appel, Dianne Herron, Lucy Miller, Leslie Dawn Wilson, Linda L Wright, Elizabeth M McClure, W Kenneth Poole, Betty Hastings, David K Stevenson, Susan R Hintz, Barry E Fleisher, M Bethany Ball, Carol G Kuelper, Julie C Lee, Joan M Baran, Lori E Bond, Nicholas St John, Renee P Pyle, Waldemar A Carlo, Myriam Peralta-Carcelen, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Fred J Biasini, Kirstin J Bailey, Richard V Rector, Stephanie A Chopko, Neil N Finer, Yvonne E Vaucher, Maynard R Rasmussen, Kathy Arnell, Clarence Demetrio, Martha G Fuller, Chris Henderson, Donna Posin, Edward F Donovan, Jean Steichen, Barb Alexander, Cathy Grisby, Marcia Mersmann, Holly Mincey, Jody Shively, Teresa L Gratton, Shahnaz Duara, Charles R Bauer, Ruth Everett, Alexis N Diaz, Elaine O Mathews, Kasey Hamlin-Smith, Lisa Jean-Gilles, Maria Calejo, Silvia M Frade, Silvia Hiriart-Fajardo, Yamiley Gideon, Sheldon B Korones, Henrietta S Bada, Tina Hudson, Kim Yolton, Marilyn Williams, Abbot R Laptook, Sue Broyles, Susie Madison, Jackie F Hickman, Sally Adams, Linda Madden, Elizabeth Heyne, Cristin Dooley, Seetha Shankaran, Yvette Johnson, Rebecca Bara, Geraldine Muran, Deborah Kennedy, Laura Goldston, Richard A Ehrenkranz, Patricia Gettner, Monica Konstantino, Elaine Romano, Nancy Close, Walter Gilliam
Abstract
Background: Extremely low birth weight (< or =1000 g) children have increased rates of cerebral palsy and other abnormal neurologic findings.
Objective: To investigate the stability of neuromotor findings between 18 and 30 months' adjusted age in extremely low birth weight infants. METHODS. Seven hundred nineteen extremely low birth weight infants with assessments at 18 and 30 months' adjusted age were included in this analysis. At each visit a neurologic examination, the modified gross motor function classification system, and the Bayley Scales of Infant Development II were administered. Logistic regression models were constructed to assess neonatal factors and neuromotor function at 18 months of age associated with stability in neuromotor function.
Results: Eighty-four percent of the children had agreement in neurologic/motor function at both visits. However, classification changed from normal to abnormal in 6% and from abnormal to normal in 10%. Diagnosis of cerebral palsy was consistent for 91% of the children, and the gross motor function classification system score was consistent for 83%. In multivariate models, factors associated with decreased severity or absence of cerebral palsy diagnosis at 30 months of age were higher gestational age, no periventricular leukomalacia or severe intraventricular hemorrhage, and a gross motor function classification system score of 0 (normal) at the 18-month visit, whereas factors associated with a new cerebral palsy diagnosis at 30 months of age were postnatal steroid use, periventricular leukomalacia or severe intraventricular hemorrhage, a gross motor function classification system score of > or =1 at 18 months of age, and asymmetrical limb movement at 18 months of age.
Conclusions: Stability of neurologic diagnosis in 84% and cerebral palsy in 91% of the children is reassuring. However, for a significant percentage of children, the neurologic diagnosis changes between 18 and 30 months of age. The diagnosis of cerebral palsy may be delayed in some infants until an older adjusted age.
Source: PubMed