Functional assessment of a multicenter very low-birth-weight cohort at age 5 years. Newborn Lung Project

Arch Pediatr Adolesc Med. 2000 Jan;154(1):23-30.


Background: Very low-birth-weight newborns (birth weight < or = 1500 g) experience serious neonatal complications, but long-term outcomes are not completely known. Most studies reflect an era of neonatal care that was fundamentally different from the present.

Objectives: To compare the functional level of very low-birth-weight children before and after surfactant introduction and to relate functional level to clinical and socioeconomic factors.

Design: Inception cohort followed up from birth to an average age of 5 years.

Setting: Six regional neonatal intensive care units in a contiguous geographic area.

Participants: Four hundred twenty-five very low-birth-weight children, born between August 1, 1988, and June 30, 1991, of 438 located among 626 whose parents provided follow-up information before neonatal intensive care unit discharge.

Interventions: None.

Main outcome measures: Diagnosis of cerebral palsy and standardized scores for self-care, mobility, and social function from the Pediatric Evaluation of Disability Inventory.

Results: Cerebral palsy was present in 12.6% of the children, with no change after surfactant introduction. Intraventricular hemorrhage (odds ratio, 2.3 per grade; 95% confidence interval, 1.8-2.8) and bronchopulmonary dysplasia (odds ratio, 2.3; 95% confidence interval, 1.2-4.6) were independently predictive of cerebral palsy and of functional outcome. For self-care, mobility, and social function, 11.7%, 29.5%, and 10.7% of the children, respectively, scored at least 2 SDs below the normative means. Social function was 0.25 to 0.50 normative SDs lower after general surfactant availability than before general surfactant availability.

Conclusions: While there was no increase in major disability after surfactant introduction, there may have been a decrease in social function associated with the lower neonatal mortality. Most very low-birth-weight children functioned within the normal range in everyday tasks. Several predictors of outcome were identified.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Bronchopulmonary Dysplasia / therapy
  • Cerebral Palsy / epidemiology
  • Child Development*
  • Child, Preschool
  • Cohort Studies
  • Disability Evaluation
  • Female
  • Follow-Up Studies
  • Humans
  • Infant, Newborn
  • Infant, Very Low Birth Weight* / growth & development
  • Intensive Care Units, Neonatal
  • Male
  • Pulmonary Surfactants / therapeutic use
  • Self Care
  • Socioeconomic Factors
  • Time Factors


  • Pulmonary Surfactants