OBJECTIVE:To evaluate risk factor profiles associated with clinically significant pulmonary hemorrhage (PH) in preterm (PT) and term infants. STUDY DESIGN:Case-control study of all infants with PH cared for in three Harvardaffiliated neonatal intensive care units between 1987 and 1994. RESULTS:A total of 50 cases of PH occurred in PT infants (gestational age (GA) of Յ34 weeks), and 26 cases occurred in near-term/full-term (NT/FT) infants (GA of Ͼ34 weeks). The median age at the time of PH was 46 hours among PT infants compared with 6 hours among NT/FT infants. For PT infants, four factors best predicted PH: a GA of between 24 and 26 weeks and antenatal glucocorticoid treatment reduced the risk (odds ratios (ORs) of 0.7 and 0.3, respectively), whereas requirement for resuscitation with positive pressure ventilation and thrombocytopenia were associated with increased risk (ORs of 4.3 and 4.0, respectively). Among the NT/FT infants, the model included three variables: meconium aspiration (OR 4.9), requirement for resuscitation with positive pressure ventilation (OR 2.9), and hypotension (OR 3.5). CONCLUSION:Antecedent factors and timing of PH differ between PT and NT/FT infants, suggesting that the mechanisms contributing to PH are influenced by developmental maturity as well as perinatal and neonatal medical conditions and interventions.

Objective: To identify specific risk factors for epilepsy for individuals born extremely preterm. Study Design: In a prospective cohort study, at 10 year follow-up, children were classified as having epilepsy or seizures not associated with epilepsy. We evaluated for association of perinatal factors using time-oriented, multinomial logistic regression models. Results: Of 888 children included in study, 66 had epilepsy and 39 had seizures not associated with epilepsy. Epilepsy was associated with an indicator of low socioeconomic status, maternal gestational fever, early physiologic instability, postnatal exposure to hydrocortisone, cerebral white matter disease and severe bronchopulmonary dysplasia. Seizure without epilepsy was associated with indicators of placental infection and inflammation, and hypoxemia during the first 24 postnatal hours. Conclusion: In children born extremely preterm, epilepsy and seizures not associated with epilepsy have different risk profiles. Though both profiles included indicators of infection and

Aim Compared to infants born at term, children born very preterm are at increased risk of visual dysfunctions, and neonatal systemic inflammation. Here we explore if these two propensities are related. Methods As part of the ELGAN study, the concentrations of 16 mediators of inflammation were measured in blood obtained on postnatal days 1, 7, 14, 21 and 28 from 1062 children born before the 28th week of gestation. Presence of visual field deficit, strabismus, and/or impaired visual fixation was recorded at age two. The concentrations of each protein were divided into quartiles within gestational week categories. We calculated odds ratios with 99% confidence intervals for having each disorder comparing children with concentration in the top quartile of each protein to children whose concentration was in the lower quartiles on the corresponding day. Analyses were adjusted for gestational age and birth weight Z-score. Results Only one of 90 assessments (16 proteins on 5 different days) was significant for visual field deficit, and one for impaired fixation. No association was found between strabismus and any inflammatory mediator. Conclusion None of the three neuro-ophthalmologic dysfunctions assessed at two years appears to be associated with systemic inflammation measured the first four postnatal weeks.

INTRODUCTION: Few studies have examined the relationship between birth plurality and neurocognitive function among children born extremely preterm. STUDY DESIGN: We compared rates of Z-scores ≤ −2 on 18 tests of neurocognitive function and academic achievement at age 10 years in 245 children arising from twin pregnancies, 55 from triplet pregnancies, and 6 from a septuplet pregnancy to that of 568 singletons, all of whom were born before the 28th week of gestation. RESULTS: 874 children were evaluated at age 10-years. After adjusting for confounders, children of multifetal pregnancies performed significantly better on one of 6 subtests of executive function than their singleton peers. Performance was similar on all other assessments of intelligence, language, academic achievement, processing speed, visual perception, and fine motor skills. CONCLUSION: We found no evidence that children born of multifetal pregnancies had worse scores than their singleton peers on assessments of neurocognitive and academic function.