Objectives: The purpose of this study was to examine developmental enamel defects and dental caries in very low birth weight adolescents with high risk (HR-VLBW) and low risk (LR-VLBW) compared to full-term (term) adolescents. Methods: The sample consisted of 224 subjects (80 HR-VLBW, 59 LR-VLBW, 85 term adolescents) recruited from an ongoing longitudinal study. Sociodemographic and medical information was available from birth. Dental examination of the adolescent at the 14-year visit included: enamel defects (opacity and hypoplasia); decayed, missing, filled teeth of incisors and molars (DMFT-IM) and of overall permanent teeth (DMFT); Simplified Oral Hygiene Index for debris/calculus on teeth, and sealant presence. A caregiver questionnaire completed simultaneously assessed dental behavior, access, insurance status and prevention factors. Hierarchical analysis utilized the zero-inflated negative binomial model and zero-inflated Poisson model. Results: The zero-inflated negative binomial model controlling for sociodemographic variables indicated that the LR-VLBW group had an estimated 75% increase (p < 0.05) in number of demarcated opacities in the incisors and first molar teeth compared to the term group. Hierarchical modeling indicated that demarcated opacities were a significant predictor of DMFT-IM after control for relevant covariates. The term adolescents had significantly increased DMFT-IM and DMFT scores compared to the LR-VLBW adolescents. Conclusion: LR-VLBW was a significant risk factor for increased enamel defects in the permanent incisors and first molars. Term children had increased caries compared to the LR-VLBW group. The effect of birth group and enamel defects on caries has to be investigated longitudinally from birth.

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 longitudinallyassessedatage3and8years.Threeseveritygroups (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.

Objective: This retrospective analysis assessed the relationship between medical treatment (postnatal steroids, surfactant) received neonatally and outcomes at 3 and 8 years using a longitudinal sample of children with bronchopulmonary dysplasia (BPD).Study Design: Four groups were formed retrospectively based on the type of neonatal medical treatment received: no drug intervention (n ¼ 37), surfactant only (n ¼ 29), postnatal steroids only (n ¼ 13) and combined surfactant and postnatal steroids (n ¼ 16). Groups were compared on neurological and medical outcomes.Result: Combined postnatal steroids and surfactant treatment was associated with more days on supplemental oxygen than no intervention or surfactant only. Surfactant replacement therapy alone was not associated with adverse consequences; however, postnatal steroid exposure appeared to be related. Conclusion:Although retrospective analyses make statements about causation impossible, the differential relationships of therapies with cognitive outcomes argues for careful monitoring of therapeutic agents with very low birth weight infants.