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Neurodevelopmental outcomes at 3 years old for infants with birth weights under 500 g
Syunsuke Nagara1, Masanori Kouwaki2, Takao Togawa3
1Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan; Department of Pediatrics, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Insights
Survival rates for extremely low birth weight infants (≤500 g) are improving, but long-term neurodevelopmental outcomes remain poor. Further research is essential to understand the prognosis for these vulnerable infants.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Survival rates for extremely low birth weight infants (birth weight ≤500 g) remain a significant clinical challenge.
- Despite advancements, the long-term prognosis for these infants requires further investigation.
Purpose of the Study:
- To clarify the long-term outcomes for surviving infants with birth weights ≤500 g.
- To assess developmental trajectories in extremely small infants.
Main Methods:
- Prospective developmental assessments at 3 years old for infants born between 2003 and 2012 with expected birth weights ≤500 g.
- Data collection included gestational age, birth weight, survival status, and neurodevelopmental evaluations.
Main Results:
- The study included 21 fetuses (10 live births, 11 stillbirths). The survival rate for live births was 80% (8/10 infants).
- All surviving infants were small for gestational age, with 88% weighing <2500 g at 40 weeks corrected age.
- Among 7 infants assessed at 3 years, 29% had normal development, 42% had mild disability, and 29% had severe disability, including cerebral palsy. Short stature was observed in 29%.
Conclusions:
- While the survival rate for extremely low birth weight infants (≤500 g) was 80%, neurodevelopmental outcomes were predominantly poor.
- Significant rates of neurodevelopmental disability and short stature highlight the challenges in managing these infants.
- Larger studies are necessary to comprehensively evaluate the long-term outcomes for extremely small infants.
Background:
Marked improvements have been achieved in the survival of extremely low birth weight infants, but survival rates and prognoses of extremely small infants with birth weights ≤500 g remain poor. The aim of this study was to clarify long-term outcomes for surviving infants with birth weights ≤500 g.
Methods:
The study population comprised fetuses of gestational age ≥22 weeks, expected live- or stillbirth weight ≤500 g, and birth date between 2003 and 2012. Developmental assessments were performed prospectively at 3 years old.
Results:
Data were obtained for 21 fetuses, including 10 live births and 11 stillbirths. Of the 10 live births, median gestational age was 25.2 weeks (range, 22.4-27.1 weeks), median birth weight was 426 g (range, 370-483 g), and two neonates died before discharge. One infant with severe asphyxia died within 12 h and another infant with Down syndrome died at 34 days. The survival rate was thus 80%. All surviving infants were small for gestational age. Seven of the 8 surviving infants (88%) weighed less than 2500 g at a corrected age of 40 weeks. Seven infants were available for developmental assessments at 3 years old. One infant could not be followed. Two of those seven infants (29%) showed normal development, three infants (42%) showed mild neurodevelopmental disability, and two infants (29%) showed severe neurodevelopmental disability. One infant had periventricular leukomalacia and cerebral palsy. Two of the seven infants (29%) had short stature (<3 SD) at 3 years old.
Conclusion:
Although the survival rate among live births was good (80%) in this study, neurodevelopmental outcomes remained poor in infants with birth weights ≤500 g. Further large studies are needed to assess long-term outcomes for extremely small infants.