537 - Neurodevelopmental Outcomes of Very Low Birth Weight Infants after Exposure to Late Systemic Postnatal Steroids

Publication Number: 537.5711

Karine Barseghyan, Kaiser Permanente Bernard J. Tyson School of Medicine, Panorama City, CA, United States; Ma. Teresa Ambat, Kaiser Permanente Bernard J. Tyson School of Medicine, Panorama City, CA, United States; Kambiz K. Rezaie, Kaiser Permanente Souther California - Panorama City, Panorama City, CA, United States; Nina Jaeger, Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, United States; Karina Feliciano, Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, United States; Jing Zhang, Kaiser Permanente Research and Evaluation, pasadena, CA, United States; Meriam Makary-Botros, Kaiser Permanente Bernard J. Tyson School of Medicine, Panorama City, CA, United States; Alexandra Diamond, Kaiser Permanente panorama city, Panorama City, CA, United States; Maria Fe B.. Villosis, Kaiser Permanente Bernard J. Tyson School of Medicine, Panorama City, CA, United States

Background: Very low birth weight (VLBW) infants are at a high risk of developing cerebral palsy (CP), autism spectrum disorder (ASD), cognitive, neuromotor, and neurosensory disabilities including blindness and hearing loss (HL).

Objective: To describe the neurodevelopmental outcomes of a cohort of VLBW patients treated with a systematic Bronchopulmonary Dysplasia (BPD) prevention bundle and to evaluate if there is a correlation between late systemic postnatal steroid (SPS) use and development of CP, ASD, HL, or neurodevelopmental impairment (NDI).

Design/Methods: A cohort of 149 VLBW infants admitted at Kaiser Permanente Panorama City (KPPC) neonatal intensive care unit in 2015-2019 and treated with the BPD prevention bundle completed their neurodevelopmental follow-up at KPPC High-Risk Infant clinic. All patients received similar treatments according to BPD prevention bundle protocols except for SPS. Patients in group 1 met the criteria and received SPS using intravenous dexamethasone while patients in group 2 did not.
Data on post-discharge neurodevelopmental outcomes including diagnosis of CP, ASD, HL, and NDI measured by Bayley Scales of Infant and Toddler Development, Third Edition were compared between the two groups.

Results: Mean (SD) BW was 1068 (261) grams (range 470-1500 grams) and mean (SD) gestational age (GA) was 28.1 (2.8) weeks (range 23.7 to 35.4 weeks) in our cohort of 149 infants. Five patients developed CP (3.4%); one of whom (20.0%) received SPS and four did not receive SPS (80%). Twenty patients were diagnosed with ASD (13.4%), four of whom received SPS (20%) and sixteen did not receive steroids (80%). Four patients (2.7%) had HL and none of them received SPS. The rates of severe impairment based on cognitive, language and motor composite scores were 2.8%, 9.2% and 7.2% respectively. Patients in group 1 were statistically smaller and more premature with mean BW of 813 grams and birth GA of 25.7 weeks compared with 1140 grams and 29.6 weeks in group 2 (p < 0.0001) (Table 1).
There was no statistically significant difference in rates of CP (p=1), ASD (p=0.28), HL (p=0.58), cognitive (p=0.86), language (p=0.43), or motor scores (p=0.30) at median corrected GA of 26 months between the two groups (Table 2).
Physical and Occupational Therapy services were utilized by 100% of patients with CP, while 95% of patients with ASD utilized Speech Therapy (Table 3).

Conclusion(s): VLBW patients who received late SPS were smaller, sicker, and more immature however did not have statistically higher rates of CP, ASD, NDI, or HL compared to their counterparts treated with the BPD prevention bundle without SPS.

Table 1: Demographics and Care Practices


Table 2: Outcomes


Table 3: Therapies