For extremely premature infants, neurodevelopmental outcomes through 2 years of age have been correlated with neonatal physiologic stability. The purpose of this study was to evaluate the long term effects of chronic physiologic instability on cognitive development. Subjects were 4 year old children born ≤ 32 wks GA between 1988 and 1993. Physiologic instability was quantified using cumulative scores for neonatal acute physiology (SNAP). Daily SNAP scores were summed over 88 infants' hospitalizations (GA 28.2 ± 2.0 wks, birthweight 1207 ± 329 g). Data on potential contributing factors, such as gestational age (GA), intracranial abnormalities (ICA), and socioeconomic status (SES) were collected. Infants were divided into SES quartiles using zipcode-specific 1990 census data. Most (74/88, 84%) of the intents fell into the highest two SES quartiles. No infants were in the fourth and lowest SES quartile. The Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) was administered to the children between the ages of 3 1/4 and 41/2 years. Full scale (FS), verbal (V), and performance (P) IQ scores were obtained. The mean FS IQ score was 103±15, the mean P IQ score was 100±15 and the mean V IQ score was 105±16. Using forward and backward stepwise regression analyses, lower GA was correlated (p<0.05) with lower FS (r=0.3431) and V IQ (r=0.3166), while higher SNAP scores correlated (p<0.05) with lower P IQ (r=0.3281). ICA and SES were not significant cofactors. The tables demonstrate the effects of lower vs. higher GA on FS and V IQ and low-moderate vs. higher SNAP scores on P IQ. Mean values ± SD follow. GA (wks) SNAP score <28 ≥28 <75%ile ≥75%ile FS IQ 97.5±13 107.1±16 * P IQ 102.4±14 94.1±14 † V IQ 100.2±14 107.6±17 † *p<0.01 †p<0.05 We conclude both gestational age and chronic physiologic instability are persistently associated with lower cognitive scores at preschool age, in this group of normally intelligent, socioeconomically advantaged children.
|Original language||English (US)|
|Journal||Journal of Investigative Medicine|
|State||Published - Jan 1 1999|
ASJC Scopus subject areas
- Biochemistry, Genetics and Molecular Biology(all)