Very-Low-Birthweight Infants at

To determine whether history of chronic lung disease (CLD) in children born at very low birthweight (VLBW) confers additional risk for impaired health, growth, and neurodevelopment, 17 VLBW children born in 1984 who had CLD (requiring supplemental oxygen more than 30 days after birth) in infancy and 28 VLBW children who did not have CLD were assessed at age 7 years. Assessments included a medical history, standard physical and neurological examinations, pulmonary-function tests, and tests of neuropsychological and psychoeducational functioning. Health status did not differ between the groups. In contrast, children with CLD did not perform as well in neuropsychological and psychoeducational assessments. Although CLD confers little added risk to health, it seems to add significantly to risks for poor school performance that are known to be associated with very low birthweight. remature birth and low birthweight are the major determinants of infant mortality and contribute disproportionately to disabilities in childhood. Prolonged respiratory insufficiency, usually due to severe respiratory distress syndrome (RDS) complicated by bronchopulmonary dysplasia (BPD), is a frequent concomitant of extreme prematurity and very-low birthweight. Although the developmental and health outcomes for very-low birthweight (VLBW) infants (less than 1500 grams) have been the subject of many investigations, there have been few attempts to examine the risk specifically conveyed by CLD, particularly at school age. Reports of outcome during early childhood have suggested that young children who had prolonged respiratory insufficiency associated with VLBW have impaired growth, delayed mental and motor development, increased morbidity due to respiratory infections, higher rehospitalization and post-neonatal mortality rates compared to VLBW infants without such respiratory problems (Bozynski et al., 1987; Markestad and Fitzhardinge, 1981; Landry et al., 1984; Berman et al., 1986; Sauve and Singhal, 1985; Meisels et al., 1986; Schreiner et al., 1987; Mayes et al., 1983; Yu et al., 1983; Shankaran et al., 1984; Stahlman et al., 1982; Vohr et al., 1982; Goldson, 1984; Rothberg et al., 1983; Ruiz et al., 1981). Little information is available about the effect of CLD on families, but there is some evidence that smaller and sicker premature infants, which would include those infants with CLD, may be at higher risk for subsequent abuse and neglect (Hunter et al., 1978, Leonard et al., 1990). This report describes the health and developmental status of a cohort of 17 VLBW children with CLD and 28 VLBW children without CLD who were cared for in our institution in 1984. Children were evaluated at 7 years of age along the domains of health status, neuropsychological functioning, lung function, and growth. This study provides information on the specific risk conveyed by CLD on a background of VLBW at school age, as well as the long term sequelae of VLBW. Risk Conveyed By Very-Low Birthweight at School Age Although some studies of children born at VLBW report a low prevalence of serious handicapping or disabling sequelae at school age (Veen et al., 1991; Kitchen et al., 1992), questions remain about