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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants in the
Deanne Wilson-Costello1, Harriet Friedman, Nori Minich
1Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA. drfjcmd@aol.com
Insights
Improved perinatal care has increased survival for extremely low birth weight infants, but with a higher risk of neurodevelopmental impairment. Parents need to be informed of these risks for informed decision-making.
Area of Science:
- Neonatology
- Perinatal Care
- Developmental Pediatrics
Background:
- Advances in perinatal care have improved survival rates for extremely low birth weight (ELBW) infants.
- Surfactant therapy was introduced in 1990, marking a significant change in ELBW infant care.
- This study compares outcomes before and after the introduction of surfactant therapy.
Purpose of the Study:
- To examine changes in survival and neurodevelopmental impairment rates in ELBW infants.
- To compare outcomes in two distinct periods: pre-surfactant therapy (1982-1989) and post-surfactant therapy (1990-1998).
- To assess the impact of surfactant therapy on ELBW infant outcomes at 20 months corrected age.
Main Methods:
- A retrospective analysis of 496 ELBW infants (500-999 g) from 1982-1989 (Period I) and 682 from 1990-1998 (Period II).
- Outcomes assessed at 20 months corrected age included death, survival with and without neurodevelopmental impairment.
- Logistic regression, adjusted for gestational age, was used for statistical comparison between the two periods.
Main Results:
- Survival rates increased from 49% in Period I to 67% in Period II.
- Neonatal morbidities like sepsis, periventricular leukomalacia, and chronic lung disease increased.
- The overall rate of neurodevelopmental impairment rose from 26% to 36%, with increased rates of neurologic abnormalities and deafness.
Conclusions:
- Improved survival for ELBW infants in the 1990s was associated with a higher risk of significant neurodevelopmental impairment.
- Prospective parents of ELBW infants require counseling regarding these increased risks.
- Informed decision-making in the delivery room is crucial for parents of ELBW infants.
Background:
Advances in perinatal care have resulted in increased survival rates for extremely low birth weight children. We sought to examine the relative changes in rates of survival and neurodevelopmental impairment at 20 months of corrected age among 500- to 999-g birth weight infants born at our perinatal center during 2 periods, before and after the introduction of surfactant therapy in 1990.
Methods:
Four hundred ninety-six infants with birth weights of 500 to 999 g were born at our perinatal center during period I (1982-1989) (mean body weight: 762 g; mean gestational age: 25.8 weeks) and 682 during period II (1990-1998) (mean body weight: 756 g; mean gestational age: 25.5 weeks). Rates of death and survival with and without neurodevelopmental impairment at 20 months of corrected age for the 2 periods were compared with logistic regression analyses, with adjustment for gestational age.
Results:
Survival rates increased from 49% during period I to 67% during period II. Neonatal morbidity rates also increased during period II, including rates of sepsis (from 37% to 51%), periventricular leukomalacia (from 2% to 7%), and chronic lung disease, defined as oxygen dependence at 36 weeks of corrected age (from 32% to 43%). Rates of severe cranial ultrasound abnormalities were similar (22% vs 22%). Among children monitored, the rate of neurologic abnormalities, including cerebral palsy, increased from 16% during period I to 25% during period II and the rate of deafness increased from 3% to 7%. The overall rate of neurodevelopmental impairment (major neurosensory abnormality and/or Bayley Mental Developmental Index score of <70) increased from 26% to 36%. Compared with period I, in period II there were decreased rates of death (odds ratio [OR]: 0.3; 95% confidence interval [CI]: 0.2-0.4) and increased rates of survival with impairment (OR: 2.3; 95% CI: 1.7-3.3) but also increased rates of survival without impairment (OR: 1.7; 95% CI: 1.3-2.2). Compared with period I, for every 100 infants with birth weights of 500 to 999 g born in period II, 18 additional infants survived, of whom 7 were unimpaired and 11 were impaired.
Conclusions:
The improved survival rates in the 1990s occurred with an increased risk of significant neurodevelopmental impairment. Prospective parents of extremely low birth weight infants should be advised of this substantial risk, to facilitate decision-making in the delivery room.
