Abstract 1471

The focus of this study was to assess neurological status over time in a group of infants who had various medical complications at birth. The hypothesis tested whether neurological status of children discharged from the Neonatal Intensive Care Unit (NICU) will vary as a function of neonatal morbidity over time. The infants born from 1985-89 were grouped according to their medical status at the time of enrollment. The retention rate ranged from 82-100% over the five time points. The sample included 188 children, 39 normal, healthy full term infants who were delivered from mothers with uncomplicated labors and deliveries and 149 preterm infants who were classified into subgroups based on clinical diagnosis. (Table)

Table 1 No caption available

At hospital discharge the children were classified by neurological examination based on the combined methods of Prechtl and the Collaborative Perinatal Study. The three classifications were normal, (no neurological abnormality), suspect, (deviation of tone, posture, movement patterns, reflexes, or head growth), or abnormal (meningitis, seizures, grade 3 and 4 intraventricular hemorrhage (IVH), and shunted hydrocephalus). At 18 months, 30 months, 4 years, and 8 years, the classification criteria were expanded using age appropriate norms at each time point. Interrater reliability was established at .95 between all examiners.

The distribution of neurological classification for all groups over time were examined. The results will be discussed in relation to each group. For example, the distribution for the healthy preterm group was similar to the healthy full term group with fewer children classified as normal and more children classified as suspect. The distribution for the remaining three preterm groups were distinctly different. The percentage of Sick Preterm infants classified as abnormal increased continuously at each time point with a total of 23% abnormal at age 8. The distribution over time for the Neuro Preterm group found 29% abnormal at 18 months, and 45% abnormal at age 8.

Hierarchical log linear analysis examined changes in neurological status by perinatal morbidity group. For these data, the independent variables were 5 perinatal groups and a constructed change index representing neurological status change over the five time points. The three categories of the change index were (a) no change of neurological status over time, (b) positive change, improvement in neurological status, and (c) negative change, decline in neurological status. A significant interaction was found between perinatal birth group and the change index indicating that preterm heterogeneity influences neurological status change over time. Repeated neurological classification in NICU children from neonatal discharge to school age could increase our understanding of recovery from perinatal insult.

funded by NIH NICHD Grant #RO1 MD 1-9195; NIH NINR Grant # NR02263 and Grant # NR0369.