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Updated: May 3, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Beyond the borderline: outcomes for inborn infants born at ≤500 grams
Amy Keir1, Andrew McPhee, Dominic Wilkinson
1Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, Australia.
Insights
Extremely low birthweight infants (ELBW) face high risks. Survival for appropriate-for-gestational-age (AGA) ELBW infants under 500g was rare, with most survivors experiencing neurodevelopmental disability.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Perinatal Medicine
Background:
- Extremely low birthweight (ELBW) infants (≤500g) present significant challenges in survival and long-term outcomes.
- Understanding the neurodevelopmental trajectory and morbidity in this vulnerable population is crucial for clinical management and parental counseling.
Purpose of the Study:
- To assess survival rates, morbidity, and neurodevelopmental outcomes in a cohort of ELBW infants.
- To provide evidence to support decision-making and counseling for families of ELBW infants.
Main Methods:
- A retrospective cohort study was conducted on all inborn infants born alive with birthweights ≤500g and gestational age ≥22 weeks.
- Data were collected over a 6-year period (2005-2010) from a single tertiary hospital.
- Standardized medical and psychological assessments were performed at 12 and 36 months corrected age.
Main Results:
- Out of 36 ELBW infants, 26 were small for gestational age (SGA).
- Overall survival rate was 39%, with only 6% surviving without neurodevelopmental disability.
- Appropriate-for-gestational-age (AGA) infants had significantly lower survival rates compared to SGA infants, with only one surviving to discharge with severe disability.
Conclusions:
- ELBW infants, particularly AGA infants, face a high risk of mortality and significant neurodevelopmental impairment.
- The findings underscore the need for specialized care and highlight the challenges in achieving favorable outcomes for this high-risk group.
- This study offers valuable data for counseling families and informing clinical practice regarding ELBW infant care.
Aim:
To report survival, morbidity and neurodevelopmental outcome in a cohort of extremely low birthweight infants.
Methods:
Retrospective cohort study of all inborn infants born alive with birthweights ≤500 g ≥22 weeks gestation at Women's and Children's Hospital, Adelaide, Australia, over a 6-year period (2005-2010). Outcome data including standardised medical and psychological assessments at 12 and 36 months corrected age were collated from follow-up.
Results:
A total of 36 eligible infants were born over the study period (mean gestational age (GA) 24.4 (range 22.0-30.0) weeks; birthweight 443 (330-500) grams). Twenty-six of the 36 (72%) infants were small for gestational age (SGA).Ten of the 36 infants received compassionate care and died in the delivery or operating room. Twenty-six of the 36 infants were admitted to the neonatal intensive care unit (NICU), of whom 12 (46%) died during their admission. At age 12 months corrected, 2/14 (14%) of survivors had none/minimal, 4/14 (29%) had mild and 8/14 (57%) had moderate/severe neurodevelopmental disability. Overall, the survival rate was 39%, and survival without neurodevelopmental disability was 6%. Only 1/10 appropriate-for-gestational-age (AGA) infants survived to discharge (and had severe disability), whereas 13/26 (50%) of all SGA infants in the study survived to discharge. Of all infants admitted to the NICU, 11/26 (42%) survived without severe neurodevelopmental disability at latest follow-up.
Conclusions:
There was a high risk of death or impairment in this cohort of infants. Survival was rare for AGA infants weighing ≤500 g at birth. Our study provides an evidence base to assist counselling and decision-making.
