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[Changes in the developmental outcome of very low and extremely low birth weight infants at 24 months' corrected age
1Gynekologicko-porodnicka klinika, Praha. petr.zoban@lfmotol.cuni.cz
Insights
Survival rates for very low birth weight (VLBW) infants have increased, with a concurrent decrease in developmental impairments (DI). This indicates an improved prognosis for intact development in these vulnerable newborns.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Epidemiology
Context:
- Study focuses on very low birth weight (VLBW) infants born between 1997-2007 in perinatal centers.
- Examines trends in survival and developmental outcomes at 24 months corrected age.
- Utilizes data from a prospective epidemiological study with follow-up in neonatal level III centers.
Purpose:
- To determine the incidence of developmental impairments (DI) in VLBW infants.
- To evaluate the changing prognosis for intact development in VLBW infants over a decade.
- To analyze trends in neonatal morbidity and survival rates.
Summary:
- Live birth rates for VLBW infants increased by 39.5% from 1997-2007, with a significant decrease in in-hospital mortality.
- Neonatal morbidity, excluding infections, declined, alongside significant reductions in cerebral palsy and visual impairment.
- Despite increased survival, particularly for infants under 1000g, the prognosis for intact development has not worsened.
Impact:
- Demonstrates improved outcomes for VLBW infants, challenging previous assumptions about increased survival leading to poorer development.
- Provides crucial data for refining neonatal care strategies and support for high-risk newborns.
- Highlights a positive trend in the quality of survival for extremely preterm infants.
Objective:
To describe the incidence of developmental impairments (DI) among very low birth weight (VLBW) infants at 24 months' corrected age, born in perinatal centers in 1997-2007, and evaluate their changing prognosis of intact development.
Design:
Prospective epidemiological study.
Setting:
Follow-up clinics of neonatal centers level III.
Methods:
Live birth rate, in-hospital mortality, neonatal morbidity, DI and quality of survival were assessed. Neonatal morbidity was analyzed in periods 2000/2, 2003/5, and 2006/7 by the data of Institute of Health Informatics and Statistics. DI and quality of survival were evaluated in cohorts of VLBW infants born in 1997/9 (period I), 2000/2 (period II), 2003/5 (period III) and 2006/7 (period IV).
Results:
Live birth rate of VLBW newborns in 1997-2007 increased in total of 39.5%, in-hospital mortality decreased, significantly in 1997-9 (fall of 10%). Neonatal morbidity, except infections, also declined. Significant decrease in DI-CP and visual impairment, was observed after period II, in category 1000-1499 g of 7/1.5%, in infants <1000 g of 8/7% resp. After period II, the prevalence of impaired children 1000-1499 g decreased of 5%, whereas in category < 1000 g only small decrease of 2% occurred in period III. Number of children without impairment increased gradually in both categories.
Conclusions:
The study showed significant increase in surviving VLBW infants, especially in category <1000 g. Increased survival rate at concurrent fall in severe neonatal morbidity (except infections) was not accompanied with worsened prognosis of an intact development.
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