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The outcome of extremely low birthweight infants
A L Järvenpää1, M Vlrtanen, M Pohjavuori
1Children's Hospital, University of Helsinki, Finland.
Insights
Survival rates for extremely low birthweight infants (ELBWI) improved significantly between 1978-89. Despite more high-risk infants, neurodevelopmental outcomes and major disabilities decreased, indicating better care for these vulnerable newborns.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Extremely low birthweight infants (ELBWI), defined as those weighing less than 1000 grams, represent a vulnerable population with significant risks for adverse neurodevelopmental outcomes.
- Improved neonatal care has led to increased survival rates for ELBWI, necessitating an understanding of their long-term developmental trajectories.
Purpose of the Study:
- To evaluate the neurodevelopmental outcomes and incidence of major disabilities in extremely low birthweight infants (ELBWI) over a 12-year period.
- To identify factors associated with poor neurodevelopment in this cohort.
- To assess the predictive value of early neurological status on long-term outcomes.
Main Methods:
- A prospective follow-up study of all surviving extremely low birthweight infants (ELBWI) born between 1978 and 1989 in Southern Finland, followed up to six years of age.
- Data collection included birthweight, gestational age, incidence of intraventricular hemorrhage, sepsis, and neurodevelopmental assessments at 2, 4, and 6 years.
- Neurological status at one year was used to predict outcomes at four years.
Main Results:
- The number of liveborn ELBWI increased, with a greater proportion of smaller infants (birthweight < 800g, gestational age < 27 weeks).
- Despite this, the proportion of infants without intraventricular hemorrhage increased from 50% to 85%, and normal neurodevelopment at two years improved from 40-70% to 63-84%.
- The rate of major disabilities decreased from 28% to 8%. Sepsis, year of birth, intraventricular hemorrhage, and birthweight were associated with poor neurodevelopment. Neurological status at one year was a strong predictor of four-year outcomes. Normal ELBWI at six years showed immature visuomotor coordination (50%), emotional immaturity (25%), and language delay (13%).
Conclusions:
- Increased survival of extremely low birthweight infants (ELBWI) in this cohort was not associated with a rise in handicaps.
- Improvements in neonatal care have positively impacted neurodevelopmental outcomes and reduced major disabilities in ELBWI.
- While significant progress has been made, subtle neurodevelopmental challenges like visuomotor and language delays persist in neurologically normal ELBWI.
Abstract:
During the years 1978-89, all surviving extremely low birthweight infants (BW less than 1000 g, ELBWI) in the region of Southern Finland were admitted to the Children's Hospital, University of Helsinki and followed up to six years. The number of liveborn ELBWI increased from 30 to 50/year during the first and last third of the follow-up. During the same twelve year period, the number of the surviving infants increased from 8 to 25/year, with the number and proportion of infants with birthweights of less than 800 g and with gestational ages of less than 27 weeks increasing from 3 to 15/year. Despite of the greater proportion of smaller infants the proportion of infants without intraventricular hemorrhage increased from 50 to 85%. The proportion of children with normal neurodevelopment at two years increased from 40-70% during the first five years of the study, to 63-84% during the last three years of the study. The proportion of children with major disabilities decreased from 28 to 8%. The factors associated with poor neurodevelopment were sepsis, year of birth, intraventricular hemorrhage, and birthweight. The neurological status at one year was a valid predictor of the outcome: at four years 94% of the infants were assessed and normal remained normal as neurologically abnormal remained abnormal or slightly abnormal. The neurologically normal ELBWI were tested at six years: visuomotor coordination was immature in 50%, emotional immaturity was found in 25% and delay of language development in 13%. In our unit increased survival of ELBWI infants has not been associated with an increase in the number of ELBWI infants with handicaps.(ABSTRACT TRUNCATED AT 250 WORDS)