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Predictors of Mortality, Morbidity, and Disability in a Cohort of Infants 28 Weeks' Gestation

Associate Professor, Departments of Pediatrics and Rehabilitation Medicine, SUNY at Buffalo

Germaine M. Buck, Ph.D.

Clinical Assistant Professor, Department of Social and Preventive Medicine, SUNY at Buffalo

Brian T. Rogers, M.D.

Assistant Professor, Departments of Pediatrics and Neurology, SUNY at Buffalo

Linda C. Duffy, Ph.D.

Assistant Professor, Department of Pediatrics, School of Medicine and Biomedical Sciences, SUNY at Buffalo, Buffalo, New York

Sharon R. Mallen, M.D.

Resident in Internal Medicine, University of Rochester School of Medicine, Rochester, New York

Nancy L. Catanzaro, R.N., P.N.P.

Pediatric Nurse Practitioner, Robert Warner Rehabilitation Center, Children's Hospital of Buffalo, Buffalo, New York

This study attempted to identify predictors for mortality, morbidity, disability, and educational handicap at age 4 years in a cohort of 194 infants born at 23 to 28 weeks' gestation at one regionalized tertiary center from 1983 to 1986. Forty-one infants died (21%); standardized neurodevelopmental and functional assessments were conducted on 149 of 153 (97%) survivors at a mean age of 52 months. Five significant predictors of death were identified with logistic regression analysis: gestational age 23 to 26 weeks, intraventricular hemorrhage grades 3 or 4, male gender, five-minute Apgar 3, and absence of prophylactic calf lung surfactant extract. Significant predictors of neurodevelopmental morbidity included sepsis, male gender, and nonwhite race. Significant predictors of disability at age four included neurodevelopmental impairment and severe retinopathy of prematurity. Low socioeconomic status, nonwhite race and male gender were predictive of educational handicap. These findings suggest that outcomes may have distinct pathophysiologies. The role of biomedical events appears strongest for death.

Clinical Pediatrics, Vol. 32, No. 9, 521-527 (1993)
DOI: 10.1177/000992289303200903


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