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Changing prognosis for very low birth weight infants
P M Ehrenhaft1, J L Wagner, R C Herdman
1Office of Technology Assessment, Congress of the United States.
Obstetrics and Gynecology
|September 1, 1989
Summary
Neonatal intensive care has significantly improved survival rates for very low birth weight infants. However, while survival has increased, the rate of serious long-term disability among these vulnerable infants has remained stable.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Outcomes Research
Background:
- Obstetric decisions for extremely premature infants rely on long-term prognosis.
- Very low birth weight (VLBW) infants (<1500 g) represent a vulnerable population with significant mortality and morbidity risks.
- Understanding trends in survival and disability is crucial for guiding clinical care and parental counseling.
Purpose of the Study:
- To update mortality and morbidity trends for subgroups of VLBW infants.
- To assess changes in survival rates and long-term disabilities over the past decade.
- To provide data for informed obstetric and neonatal decision-making.
Main Methods:
- A systematic review and data pooling from multiple perinatal center reports.
- Analysis of mortality and morbidity trends stratified by birth weight subgroups.
- Longitudinal assessment of major handicaps in surviving infants at 1-2 years of age.
Main Results:
- Significant improvements in neonatal mortality rates for inborn VLBW infants (<1500 g) over the last 10 years.
- Substantial survival gains observed in the 750-1000 g birth weight group, with approximately 70% survival currently.
- Mortality remains high (<750 g), with significant center-to-center variability (50-70% survival in some centers).
- The proportion of survivors with serious long-term disabilities has not significantly changed since the introduction of neonatal intensive care.
- Major handicaps at 1-2 years affect 26% of survivors <800 g, 17% of survivors 750-1000 g, and 11% of survivors 1000-1500 g (born 1975-1985).
Conclusions:
- Neonatal intensive care has led to improved survival for VLBW infants, particularly in the 750-1000 g range.
- Despite increased survival, the rate of serious long-term disability among survivors has not decreased, likely due to the survival of more severely ill infants.
- Continued monitoring and research are essential to further improve outcomes and reduce long-term morbidities in extremely premature infants.