Cognitive Development and Quality of Life Associated With BPD in 10-Year-Olds Born Preterm

Abstract

Objectives: To compare neurocognitive, language, executive function, academic achievement, neurologic and behavioral outcomes, and quality of life at age 10 years in children born extremely preterm who developed bronchopulmonary dysplasia (BPD) to children who did not develop BPD.

Methods: The Extremely Low Gestational Age Newborns study population included 863 children born extremely preterm whose BPD status before discharge was known had an IQ (Differential Ability Scales II [DAS II]) assessment at 10 years. We evaluated the association of BPD with any cognitive (DAS II), executive function (NEuroPSYchological Assessment II), academic achievement (Wechsler Individual Achievement Test-III and Oral and Written Language Scales [OWLS]) as well as social dysfunctions (Social Responsiveness Scale). We used logistic regression models, adjusting for potential confounding factors, to assess the strength of association between the severity of BPD and each outcomes.

Results: Three hundred and seventy-two (43%) children were oxygen-dependent at 36 weeks postconception age, whereas an additional 78 (9%) were also oxygen- and ventilator-dependent. IQ scores 2 or more SDs below the expected mean (ie, z scores ≤-2) occurred twice as commonly among children who had BPD as among those who did not. Children with severe BPD consistently had the lowest scores on DAS II, OWLS, Wechsler Individual Achievement Test-III, NEuroPSYchological Assessment II, and Social Responsiveness Scale assessments.

Conclusions: Among 10-year-old children born extremely preterm, those who had BPD were at increased risk of cognitive, language, and executive dysfunctions; academic achievement limitations; social skill deficits; and low scores on assessments of health-related quality of life.

FIGURE 1

Distribution of scores. All subtest z scores are adjusted to population norms. Light gray is ventilation and oxygen, medium gray is oxygen only, dark gray is no BPD. AA, auditory attention; AS, animal sorting; AW, arrows; GEO, geometric puzzles; INI, inhibition inhibition; INN, inhibition naming; INS, inhibition switching; LC, listening comprehension; NO, numerical operations; NV, nonverbal reasoning; OE, oral expression; PwD, pseudoword decoding; RS, auditory response set; Sp, spelling; V, verbal; VP, visuomotor precision; WM, working memory; WR, word reading.

FIGURE 2

Forest plots of adjusted odds ratios and 95% confidence intervals of a z score ≤−1 on each DAS II and NEPSY II neurocognitive assessment at age 10 associated with severe (left panel) and moderate (right panel) BPD. Odds ratios were adjusted for gestational age (23–24 and 25–26 weeks), birth weight z score (<−2 and ≥−2, <−1), delivery for maternal or fetal indications, and maternal fever within 48 hours of delivery.

FIGURE 3

Forest plots of adjusted odds ratios and 95% confidence intervals of a z score ≤−1 on each DAS II and NEPSY II neurocognitive assessment at age 10 associated with severe (left panel) and moderate (right panel) BPD for children with a DAS II IQ ≥70. Odds ratios were adjusted for gestational age (23–24 and 25–26 weeks), birth weight z score (<−2 and ≥−2, <−1), delivery for maternal or fetal indications, and maternal fever within 48 hours of delivery.

FIGURE 4

Forest plots of adjusted odds ratios and 95% confidence intervals of a T-score ≥60 on SRS subtests, of screening positive on SCQ, and of documented characteristics of ASD based on the ADOS2 at age 10 associated with severe (left panel) and moderate (right panel) BPD. Odds ratios were adjusted for gestational age (23–24 and 25–26 weeks), birth weight z score (<−2 and ≥−2, <−1), delivery for maternal or fetal indications, and maternal fever within 48 hours of delivery.

FIGURE 5

Forest plots of adjusted odds ratios and 95% confidence intervals of a z score ≤−1 on the CCC2 subtests at age 10 associated with severe (left panel) and moderate (right panel) BPD. Odds ratios were adjusted for gestational age (23–24 and 25–26 weeks), birth weight z score (<−2 and ≥−2, <−1), delivery for maternal or fetal indications, and maternal fever within 48 hours of delivery.