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Neurodevelopmental outcome in babies weighing less than 2001 g at birth
Insights
Very low birth weight infants face higher risks of major and minor neurodevelopmental handicaps, including blindness and deafness. However, outcomes improved for these vulnerable infants during the study period.
Area of Science:
- Neonatal care
- Pediatric neurology
- Developmental pediatrics
Background:
- Neonatal intensive care units (NICUs) manage high-risk infants.
- Infant outcomes are influenced by birth weight and gestational age.
- Long-term neurodevelopmental follow-up is crucial for assessing NICU care effectiveness.
Purpose of the Study:
- To evaluate the neurodevelopmental outcomes of infants with low birth weights (500-2000 g).
- To identify risk factors associated with major and minor disabilities in survivors.
- To assess trends in infant survival and handicap over time.
Main Methods:
- Retrospective cohort study of 1034 infants (birth weight 500-2000 g) from 1976-1980.
- Follow-up of 654 survivors at a median age of 3 years 3 months.
- Assessment of major and minor neurodevelopmental handicaps, including neurological, visual, hearing, and speech impairments.
Main Results:
- 7.6% of survivors had major neurodevelopmental handicaps; prevalence increased with lower birth weight and gestation.
- Infants <1251 g birth weight had higher rates of major disabilities (blindness, deafness, cerebral palsy) and minor impairments (visual, hearing).
- Cognitive quotients (Griffiths, Wechsler) were not linked to birth weight/gestation but varied by socioeconomic factors; survival and handicap prognosis improved for infants <1251 g.
Conclusions:
- Low birth weight is a significant predictor of adverse neurodevelopmental outcomes.
- Early identification and intervention for disabilities in low birth weight infants are essential.
- Improvements in neonatal care have positively impacted survival and reduced handicap rates in very low birth weight infants.
Abstract:
From 1976 to 1980, 1034 infants with birth weights of 500-2000 g were cared for in the neonatal medical unit; 724 were discharged. Twenty (2.8%) subsequently died and 654 (90.3%) were followed up at a median age of 3 years 3 months. Fifty five (7.6%) survivors had major neurodevelopmental handicaps not attributable to congenital anomalies. Increasing prevalence of major handicap was found with decreasing birth weight and gestation. Children with birth weights of less than 1251 g had a higher incidence of all major disabilities. Handicapped children with a birth weight less than 1251 g were more likely to have blindness, deafness, multiple disabilities, and more severe cerebral palsy. There were 146 (20.2%) children with minor disabilities: neurological impairments (n = 11), borderline results on psychometric testing (n = 18), visual impairments (n = 52), hearing impairments (n = 40), and speech impairments (n = 71). Children weighing less than 1251 g at birth had a higher incidence of minor visual and hearing impairments. In 389 children the mean Griffiths quotient was 101.6 (SD 17.2) (range 50-147), and 158 children had a mean Wechsler preschool and primary intelligence quotient of 101.8 (13.2) (range 56-127): these quotients did not vary with birth weight or gestation but did vary with socioeconomic group, schooling, and family structure. During the study period an improving prognosis in terms of both survival and handicap was observed in children weighing less than 1251 g at birth.