LBW infants may experience problems related to their prematurity and associated perinatal complications. The lower the infant’s birth weight, the greater is the likelihood and severity of problems. Such problems can require lengthy initial hospitalizations; are often followed by the need for re-hospitalization; and can result in long-term complications involving the infant’s growth, developmental patterns, physical health, and age-appropriate functioning. LBW infants who are additionally small for gestational age under SSA’s rules (i.e., the table in listing 100.04B) are also more likely to have long-term complications.

Evidence about such medical problems and complications may support a later diary date. It is not necessary to develop for such evidence if you already have enough information to allow the case. However, if such evidence is in the file, you must consider it when setting the CDR diary. Medical conditions that require a longer diary are discussed in DI 25235.006B.2.a.

Several medical factors support longer diaries, because they tend to be associated with long-term complications:

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  Lower birth weights

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  The types of medical problems discussed in DI 25235.006B.2.a.

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  Being small for gestational age under SSA’s rules (see the table in listing 100.04B)

If it is expected that the infant will no longer be disabled when the infant attains age 1, set a MIE diary for age 1. Use MIE Reason Code D, per DI 26525.025B.2.

If it is expected that the infant will still be disabled when the infant attains age 1, set a MIE, MIP, or MINE diary for a later date, as appropriate, based on:

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  the evidence in the case record; and

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  clinical judgment regarding when it is expected that the infant will no longer be disabled; and

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  the specific criteria for setting later medical diaries in DI 25235.006B.2.

For most LBW infants, the presence of one or more of these conditions directs a later diary date, because they tend to be associated with a poorer long-term prognosis. It is not necessary to develop for evidence of these conditions, but if the evidence is in file at adjudication, you must consider it in setting the CDR diary. See DI 25235.006B.1.b. and DI 25235.006B.1.c. for specific instructions for each weight range.

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  Cerebral white matter insult (periventricular leukomalacia, intraventricular hemorrhage (IVH) grade 3-4, ventriculomegaly)

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  Chronic lung disease of infancy (CLD), previously known as bronchopulmonary dysplasia, or BPD

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  Retinopathy of prematurity (ROP), stage 3 or greater

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  Necrotizing enterocolitis (NEC) requiring bowel resection surgery

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  Small for gestational age under our rules (i.e., see the table in listing 100.04B)

Follow the chart below to set minimum diary dates for infants who are found disabled under listing 100.04A (birth weight of less than 1200 grams). The DDS consultant may decide that longer diaries are appropriate in some cases.

CA = chronological age

Although these infants have higher birth weights than those described in listing 100.04A, they are small for gestational age under SSA’ rules, a condition that tends to be associated with a poor long-term prognosis. For infants found disabled under listing 100.04B (birth weight between 1250 grams – 2000 grams), set a minimum diary date at 24 months of chronological age. The DDS consultant may decide that longer diaries are appropriate in some cases.

See the table in listing 100.04B to determine “small for gestational age” under our rules.

Problems such as intraventricular hemorrhage and retinopathy of prematurity are less common in gestationally more mature infants. When they are present, however, take this information into account when setting the diary date.