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Analysis Using a Severity-Based Classification System

Elizabeth J. Short, PhD; H. Lester Kirchner, PhD; George R. Asaad, BA; Sarah E. Fulton, MA, CCC-SLP; Barbara A. Lewis, PhD; Nancy Klein, PhD; Sheri Eisengart, PhD; Jill Baley, MD; Carolyn Kercsmar, MD; Meeyoung O. Min, PhD; Lynn T. Singer, PhD

Arch Pediatr Adolesc Med. 2007;161(11):1082-1087.

Objective  To investigate the relationship between the severity-based definition of bronchopulmonary dysplasia (BPD), choice of treatment, and neurocognitive outcomes at age 3 and 8 years.

Design  This is a secondary analysis of data collected from a prospective, longitudinal sample of 99 children with a history of BPD.

Setting  Children born with BPD admitted to 3 hospitals from February 1, 1989, to November 31, 1991.

Participants  Ninety-nine children with BPD were longitudinally assessed at age 3 and 8 years. Three severity groups (mild, moderate, and severe) were formed based on gestational age and need for supplemental oxygen therapy.

Main Exposures  Supplemental oxygen therapy for 28 days or longer, birth weight less than 1500 g, and radiographic evidence of lung disease.

Main Outcome Measures  Neurologic and medical outcomes; type of medical management; and language, achievement, and cognitive functioning were compared among the 3 severity groups.

Results  Severity classification of BPD was associated with poorer outcomes. Compared with children with mild or moderate BPD, children with severe BPD performed more poorly on IQ tests (Mental Development Index, 90 vs 76.4; and Psychomotor Development Index, 92.5 vs 73.9) and language measures (total, 95 vs 82) at age 3 years and performance IQ (86 vs 75) and perceptual organization (86 vs 76) at age 8 years. Severity of BPD was not associated with choice of medical management but was related to educational interventions. Children with severe BPD received more special education services (69% vs 44%) than did children with mild BPD.

Conclusions  The severity-based classification clarifies the relationship between BPD and developmental sequelae. Children with severe BPD required more interventions at age 8 years than did children with mild or moderate BPD.

Author Affiliations: Departments of Psychology (Dr Short and Mr Asaad) and Pediatrics (Drs Kirchner, Lewis, Eisengart, Baley, Kercsmar, Min, and Singer and Ms Fulton), Case Western Reserve University; and Department of Education, Cleveland State University (Dr Klein), Cleveland, Ohio.