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Is there evidence that long-term outcomes have improved with intensive care?
1Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106, USA. drfjcmd@aol.com
Insights
Neonatal intensive care has improved survival for very low birth weight (VLBW) infants. However, long-term neurodevelopmental outcomes and health status require further evaluation to assess the true success of these interventions.
Area of Science:
- Neonatology
- Perinatal Medicine
- Developmental Pediatrics
Background:
- Significant advances in perinatal interventions have improved survival rates for very low birth weight (VLBW) infants over the last 30 years.
- Simultaneously, reproductive technologies have increased preterm and multiple births, contributing to infant mortality and morbidity.
- Despite improved survival, VLBW infants face substantial risks of long-term morbidities like cerebral palsy and developmental delays.
Purpose of the Study:
- To critically evaluate neurodevelopmental and health outcomes of very premature infants.
- To determine if long-term outcomes have improved with advancements in neonatal intensive care.
- To assess the success of neonatal intensive care over the past three decades.
Main Methods:
- Surveying studies on neurodevelopmental impairment rates, including cerebral palsy (CP).
- Analyzing early childhood and school-age functional problems.
- Reviewing special healthcare issues and changes over time.
Main Results:
- While survival has increased, long-term morbidities like cerebral palsy and developmental delays persist in VLBW infants.
- Ethical concerns arise regarding increased disability rates and resource utilization with improved survival.
- Data on long-term outcomes are essential to evaluate the effectiveness of neonatal intensive care.
Conclusions:
- Neonatal intensive care has enhanced survival but has not fully eliminated long-term neurodevelopmental impairments in very premature infants.
- Ongoing evaluation of long-term outcomes is crucial to guide future interventions and resource allocation.
- Further research is needed to improve the quality of life for survivors of extreme prematurity.
Abstract:
Advances in perinatal interventions over the past three decades, such as antenatal steroid therapy, ventilator techniques, surfactant therapy, and enhanced nutrition have resulted in a dramatic improvement in the survival of very low birth weight (VLBW) infants. Simultaneously, other advances in reproductive technology procedures have resulted in greater numbers of preterm and multiple births. These extremely premature births account for the vast majority of infant mortality and morbidity in the developed world. Despite the innovative interventions, VLBW infants remain at substantial risk for a wide spectrum of long-term morbidity including cerebral palsy (CP), mental retardation, developmental delay, school problems, behavioral issues, growth failure, and overall poor health status. Recently, ethical concerns have been expressed that improved survival rates for the most immature infants may result in increased rates of disability with substantial resource utilization and declining quality of life for the survivors. This chapter critically evaluates the available neurodevelopmental and health outcomes of very premature infants from the developed world in an attempt to determine if there is evidence that long-term outcomes have improved with neonatal intensive care. Studies on the rates of neurodevelopmental impairment including CP, early childhood and school age functional problems, and special health care issues are surveyed in order to evaluate changes over time and provide an assessment of the success of neonatal intensive care over the past three decades.
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