Objective To evaluate if language delay at three years in premature infants is associated with prior exposure to hyperbilirubinemia during the first two weeks after birth. Patients and Methods We performed retrospective case-control study of infants admitted to the Neonatal Intensive Care Unit between January and October 2003. Inclusion criteria included a birth weight ≤ 1500 grams and follow-up to age three years. Exclusion criteria included genetic disorders and hearing loss or recurrent ear infections. Peak total serum bilirubin (TSB) during the first two weeks and duration of hyperbilirubinemia (days with TSB > 8 mg/dl) were determined. Infants with language delay and receiving speech therapy by three years were identified through developmental clinic charts and tracking program and compared to infants who had normal language development. Results 125 infants with birth weight ≤ 1500 grams were admitted to the Neonatal Intensive Care Unit between January and October 2003. Fifteen infants died and 110 were discharged home. 102/110 (93%) of infants had follow-up to age three years. Four infants were excluded (1 genetic disorder, 3 delayed hearing loss or recurrent ear infections). 24 infants had a language delay and received speech therapy while 74 infants had normal language development. There was no significant difference in peak TSB and duration of hyperbilirubinemia between the two groups. On logistic regression, only bronchopulmonary dysplasia was associated with language delay (Adjusted odds ratio 7.3, 95% confidence interval 2.5 – 22). Conclusions Hyperbilirubinemia defined as peak TSB level or duration of elevated bilirubin in days is not associated with language delay in premature infants. However, this issue deserves investigation since other measures of bilirubin, such as unbound bilirubin may be associated with language delay.

Objectives To describe the frequency of postnatal discussions about withdrawal or withholding of life-sustaining therapy (WWLST), ensuing WWLST, and outcomes of infants surviving such discussions. We hypothesized that such survivors have poor outcomes. Study design This retrospective review included registry data from 18 centers of the National Institute of Child Health and Human Development Neonatal Research Network. Infants born at 22–28 weeks of gestation who survived >12 hours during 2011–2013 were included. Regression analysis identified maternal and infant factors associated with WWLST discussions and factors predicting ensuing WWLST. In-hospital and 18- to 26-month outcomes were evaluated. Results WWLST discussions occurred in 529 (15.4%) of 3434 infants. These were more frequent at 22–24 weeks (27.0%) compared with 27–28 weeks of gestation (5.6%). Factors associated with WWLST discussion were male sex, gestational age (GA) of ≤24 weeks, birth weight small for GA, congenital malformations or syndromes, early onset sepsis, severe brain injury, and necrotizing enterocolitis. Rates of WWLST discussion varied by center (6.4%–29.9%) as did WWLST (5.2%–20.7%). Ensuing WWLST occurred in 406 patients; of these, 5 survived to discharge. Of the 123 infants for whom intensive care was continued, 58 (47%) survived to discharge. Survival after WWLST discussion was associated with higher rates of neonatal morbidities and neurodevelopmental impairment compared with babies for whom WWLST discussions did not occur. Significant predictors of ensuing WWLST were maternal age >25 years, necrotizing enterocolitis, and days on a ventilator. Conclusions Wide center variations in WWLST discussions occur, especially at ≤24 weeks GA. Outcomes of infants surviving after WWLST discussions are poor. Trial registration ClinicalTrials.gov: NCT00063063.

Objective-To evaluate neurodevelopmental outcomes of preterm infants with need for Child Protective Services (CPS) supervision at hospital discharge compared with those discharged without CPS supervision. Study design-For infants born at <27 weeks of gestation between 2006 and 2013, prospectively collected maternal and neonatal characteristics and 18-to 26-month corrected age follow-up data were analyzed. Bayley-III cognitive and language scores of infants with discharge CPS supervision were compared with infants without CPS supervision using regression analysis while adjusting for potentially confounding variables, including entering CPS after discharge from the hospital. Results-Of the 4517 preterm infants discharged between 2006 and 2013, 255 (5.6%) were discharged with a need for CPS supervision. Mothers of infants with CPS supervision were significantly more likely to be younger, single, and gravida ≥3; to have less than a high school education; and to have a singleton pregnancy and less likely to have received prenatal care or

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