The incidence of major developmental disabilities in the extremely low birth weight (ELBW) infant has remained stable despite dramatic improvement in survival. A subset of these children consistently overcome the odds, are neurologically intact, and demonstrate normal cognitive and academic skills. The purpose of this study is to identify perinatal predictors of optimal school age outcome in a sample of ELBW children. The study group consists of 257 surviving ELBW infants (<1001 grams) admitted to Vanderbilt University Hospital July 1982-July 1989. Information regarding presence of vision or hearing impairment, cerebral palsy, mental retardation, and school difficulty(need for special education or remedial resources after meeting school system eligibility criteria) at 7-9 yrs is available for 214 of 257 children (83%). The survivors were divided into three mutually exclusive subgroups: Group 1(n=66) is children with optimal outcome, no disability or school difficulty; Group 2 (n=71) is children with school difficulty, but no major difficulty; Group 3 (n=77) is children with any major disability. Data regardingobstetric risk (prenatal care, maternal smoking, presentation and mode of delivery, antenatal steroid administration, amnionitis, fetal heart rate tracing), neonatal course (birth weight, gestation, BPD, IVH, length of stay) and sociodemographics (race, gender, maternal age, education, marital status, social risk score) were analyzed by ANOVA and chi squares in relation to school age outcome for each of the three groups. The ELBW children with major developmental disability (Group 3) had significantly lower birth weight, shorter gestation, longer hospitalization, and more severe IVH than the remaining two thirds of the survivors in Groups 1 and 2 (p<0.05). However the children with optimal school age outcome (Group 1) and the children experiencing school difficulty (Group 2) did not differ significantly from each other on any of the obstetric, neonatal, or sociodemographic variables listed above, with the exception of gender. In our sample, the ELBW child spared major disability still has a 50% risk of experiencing school difficulty regardless of perinatal factors. If optimal outcome cannot be predicted by perinatal factors, then further research is important to identify mechanisms to reduce morbidity and promote optimal cognitive outcome in the rapidly growing population of ELBW survivors.
