Objective. To examine the effects of bronchopulmonary dysplasia (BPD) and very low birth weight (VLBW) on the cognitive and academic achievement of a large sample of 8-year-old children.Methods. Infants who were VLBW and had BPD ( n = 98) or did not have BPD ( n = 75) and term infants ( n = 99) were followed prospectively to age 8. Groups were compared on measures assessing 4 broad areas of functioning: intelligence, achievement, gross motor, and attentional skills. Measures included the Wechsler Intelligence Scale for Children III, the Woodcock Johnson Test of Achievement-Revised, the Bruininks-Oseretsky Test of Motor Proficiency, the Tactual Performance Test (spatial memory), and the Continuous Performance Test (attention). School outcomes were assessed by parent and teacher report, as well as from school records. Groups were comparable on socioeconomic status, sex, and race. The total sample of BPD, VLBW, and term children was compared on all outcome measures. In addition, neurologic risk was assessed in the present sample and included the following: intraventricular hemorrhage, echodense lesions, porencephaly, hydrocephalus, ventriculoperitoneal shunt, meningitis, and periventricular leukomalacia. Individual difference analyses were conducted for neurologically intact children in all 3 groups. Finally, treatment effects were examined by comparing BPD children who had received steroids as part of their treatment with BPD children who had not.Results. The BPD group demonstrated deficits compared with VLBW and term children in intelligence; reading, mathematics, and gross motor skills; and special education services. VLBW children differed from term children in all of the above areas, except reading recognition, comprehension, and occupational therapy. Attentional differences were obtained between BPD and term children only. The BPD group (54%) was more likely to be enrolled in special education classes than VLBW (37%) or term children (25%). In addition, more BPD children (20%) achieved full-scale IQ scores 70, in the mental retardation range, compared with either VLBW (11%) or term (3%) children, with all VLBW children significantly more likely than term children to achieve IQs in the subaverage category. After controlling for birth weight and neurologic problems, BPD and/or duration on oxygen predicted lower performance IQ, perceptual organization, full-scale IQ, motor and attentional skills, and special education placement. The qualitative classification of BPD (present or absent) was a significant predictor for lower scores on measures of applied problems; motor skills; and incidence of speech-language, occupational, and physical therapies. Individual difference analyses were performed to ascertain whether differences between the risk groups were primarily attributable to neurologic complications. Even with the neurologically intact sample of BPD and VLBW children, differences between the term comparison group and both the BPD and VLBW groups were found for many outcome measures. When birth weight and neurologic complications were controlled, BPD and severity of BPD were associated with lower performance and full-scale IQ, poorer perceptual organization, attention, and motor skills, as well as lower school achievement and greater participation in special education, including occupational, physical, and speech-language therapies. Treatment protocol may in part be responsible for differences observed in our BPD sample. Steroid and nonsteroid groups of BPD children differed significantly in performance IQ (72.8 vs 84.8) and full-scale IQ (77.0 vs 85.2); perceptual organization (74.0 vs 85.2); Bruininks-Oseretsky Test of Motor Proficiency score (36.6 vs 44.7); and participation in special education (78% vs 48%), occupational therapy (71% vs 44%), and physical therapy (71% vs 41%). In every instance, BPD children who received steroids fared more poorly than BPD children who did not receive steroids.Conclusions. BPD and duration on oxygen have long-term adverse effects on cognitive and academic achievement above and beyond the effects of VLBW. The problems that have been identified at 8 years of age highlight the need for continued monitoring of the learning, behavior, and development of BPD children to intervene with children who are at risk for school problems.
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机译：目的。研究支气管肺发育不良（BPD）和极低出生体重（VLBW）对大量8岁儿童的认知和学习成绩的影响。对VLBW且有BPD（n = 98）或没有BPD（n = 75）和足月婴儿（n = 99）的婴儿进行了前瞻性随访，直至年龄为8岁。对各组进行了评估，比较了评估以下4个主要功能领域的措施：智力，成就，运动能力和注意力技能。措施包括韦氏儿童智力量表III，伍德考克约翰逊成就测验修订，布鲁因-奥塞列茨基运动能力测验，触觉表现测验（空间记忆）和持续表现测验（注意）。通过父母和老师的报告以及学校记录评估学校的成绩。小组在社会经济地位，性别和种族方面具有可比性。对BPD，VLBW和足月儿的总样本进行所有结局指标的比较。另外，在本样本中评估了神经系统风险，包括以下内容：脑室内出血，回声损害，漏气，脑积水，脑室腹膜分流，脑膜炎和脑室白细胞软化。对所有3组神经功能完好的儿童进行了个体差异分析。最后，通过比较接受类固醇治疗的BPD儿童和未接受类固醇的BPD儿童来检查治疗效果。与VLBW和足月儿童相比，BPD组表现出缺陷。阅读，数学和运动技能;以及特殊教育服务。在阅读的所有方面，VLBW儿童与足月儿童不同，除了阅读识别，理解和职业治疗。仅在BPD和足月儿童之间获得了注意差异。与VLBW（37％）或足月儿童（25％）相比，BPD组（54％）更有可能参加特殊教育课程。此外，与VLBW（11％）或足月（3％）的儿童相比，更多的BPD儿童（20％）在智力低下的范围内达到了全面的智商得分<70。儿童获得低于平均水平的智商。在控制了出生体重和神经系统问题后，BPD和/或吸氧时间可预测出较低的智商，知觉组织，全面智商，运动和注意力技能以及特殊教育位置。 BPD（有或无）的定性分类是衡量应用问题的分数较低的重要预测因素。运动技能;以及语言，职业和物理疗法的发生率。进行了个体差异分析，以确定风险组之间的差异是否主要归因于神经系统并发症。即使使用BPD和VLBW儿童的神经学上完整的样本，术语对照组与BPD和VLBW组之间的差异也存在很多结果指标。当控制出生体重和神经系统并发症时，BPD和BPD的严重程度与较低的表现和全面的智商，较差的感知组织，注意力和运动技能，较低的学业成绩和更多的特殊教育（包括职业）参与有关，物理和言语治疗。治疗方案可能部分归因于我们的BPD样品中观察到的差异。 BPD儿童的类固醇和非类固醇组的表现智商（72.8 vs 84.8）和全面智商（77.0 vs 85.2）有显着差异。知觉组织（74.0 vs 85.2）; Bruininks-Oseretsky运动能力测验分数（36.6 vs 44.7）;参与特殊教育（78％vs 48％），职业疗法（71％vs 44％）和物理疗法（71％vs 41％）。在每种情况下，接受类固醇激素治疗的BPD儿童的表现要比未接受类固醇激素治疗的BPD儿童表现更差。除了VLBW的影响外，BPD和氧气持续时间对认知和学业成就具有长期不利影响。在8岁时发现的问题突出表明，需要持续监控BPD儿童的学习，行为和发展，以干预有可能面临学校问题的儿童。
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