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Improvement in outcome for very low birthweight children: apparent or real?
W H Kitchen1, A L Rickards, L W Doyle
1Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Vic.
Insights
Survival rates for very low birthweight infants nearly doubled, with a significant decrease in severe disabilities among survivors. This improvement in neonatal care did not increase the rate of neurological impairment in these vulnerable infants.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Public Health
Background:
- Improved survival rates for very low birthweight (VLBW) infants are a key goal in neonatal care.
- Advances in perinatal care may impact long-term neurodevelopmental outcomes.
Purpose of the Study:
- To assess if increased survival of VLBW infants (birthweight < 1501 g) correlated with higher rates of neurological impairment or disability.
- To compare neurodevelopmental outcomes between VLBW infants born before and after the widespread adoption of assisted ventilation.
Main Methods:
- Prospective follow-up of two cohorts of VLBW infants to eight years of age.
- Comparison groups of infants with birthweights > 1501 g were randomly selected.
- Cohorts were defined by birth year: 1966-1970 (pre-assisted ventilation) and 1980-1982 (post-assisted ventilation).
Main Results:
- VLBW infant survival to eight years nearly doubled (37.1% to 67.8%).
- The rate of non-disabled survivors significantly increased (52.6% to 80.8%).
- Severe disabilities in survivors decreased substantially (13.6% to 4.1%), including severe sensorineural deafness and intellectual impairment.
Conclusions:
- Improved survival of VLBW infants is achievable without a concurrent rise in severe disabilities.
- Further research is needed to determine if recent perinatal care advances continue to enhance long-term outcomes.
Objective:
To determine whether improvement in the survival rate of infants with a birthweight of less than 1501 g was accompanied by an increase in the rate of neurological impairment or disability among the survivors.
Design, Setting And Patients:
Two cohorts of consecutive very low birthweight infants (birthweight less than 1501 g) in one tertiary perinatal centre were followed prospectively to eight years of age; for both cohorts, comparison groups of children of birthweight more than 1501 g were randomly selected from hospital births.
Interventions:
The first cohort was born before the introduction of assisted ventilation (1966-1970), the second after assisted ventilation was well established (1980-1982).
Main Outcome Measures:
Comparisons between cohorts, at eight years of age, of the survival rates and the rates of severe sensorineural impairments and disabilities.
Results:
The survival rate for very low birthweight infants to eight years of age almost doubled between these cohorts, from 37.1% to 67.8% (odds ratio [OR], 3.4; 95% confidence interval [CI], 2.5-4.7; chi 2 = 57.6; P much less than 0.0001). The biggest gain was the increase in non-disabled survivors at eight years of age, from 52.6% in the first cohort to 80.8% in the second cohort (OR, 3.5; 95% CI, 2.2-5.7; chi 2 = 26.7; P less than 0.0001). Furthermore, the rate of severe disabilities in survivors fell substantially, from 13.6% to 4.1% (OR, 0.31; 95% CI, 0.14-0.69; chi 2 = 8.3; P less than 0.01). Of specific impairments, the rate of severe sensorineural deafness fell substantially (3.2% to 0%: OR, 0.14, 95% CI, 0.02-0.81; chi 2 = 4.8; P less than 0.05), as did the rate of severe intellectual impairment (13.0% to 2.7%: OR, 0.25; 95% CI, 0.11-0.57; chi 2 = 10.7; P less than 0.002). Only the rate of cerebral palsy increased, but not significantly (2.6% to 6.8%; OR, 2.6; 95% CI, 0.89-7.6; chi 2 = 3.0).
Conclusions:
It has been possible to improve the survival rate of very low birthweight infants over time without increasing the number of severely disabled survivors. Whether the long-term outcome for these infants is continuing to improve with more recent advances in perinatal care remains to be determined.