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Improved outcome to two years of very low-birthweight infants: fact or artifact?
Insights
Survival rates for very low-birthweight (VLBW) infants have significantly improved. However, their neurodevelopmental outcomes, including cognitive scores, still lag behind normal-birthweight peers.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Public Health
Background:
- Survival rates for very low-birthweight (VLBW) infants have dramatically increased over recent decades.
- Improved perinatal care has led to better survival but raises questions about long-term neurodevelopmental outcomes.
Purpose of the Study:
- To compare the neurodevelopmental outcomes of VLBW survivors from different birth cohorts.
- To assess the impact of advancements in perinatal care on the cognitive and physical development of VLBW infants.
Main Methods:
- Comparative analysis of two cohorts of VLBW infants born in 1966-70 and 1980-82.
- Assessment of neurodevelopmental outcomes including Mental Development Index (MDI) using Bayley Scales, prevalence of strabismus, myopia, and cerebral palsy.
Main Results:
- Survival rates for VLBW infants increased from 37.1% (1966-70) to 68.3% (1980-82).
- The later cohort showed reduced rates of strabismus and myopia but increased cerebral palsy.
- While mean MDI improved, it did not solely attribute to perinatal care and lagged behind normal-birthweight peers.
Conclusions:
- Improved survival of VLBW infants is evident.
- Neurodevelopmental outcomes for VLBW survivors have not kept pace with survival improvements.
- Further research is needed to enhance the long-term cognitive and developmental trajectories of VLBW infants.
Abstract:
In 1966-70, the survival rate for very low-birthweight (VLBW) children born in a tertiary perinatal centre was 37.1 per cent but by 1980-82 it had increased to 68.3 per cent. The latter cohort had a significantly reduced prevalence of strabismus, myopia and a head circumference under the 10th percentile, but a significantly increased prevalence of cerebral palsy compared with the 1966-70 VLBW children. Survivors born in 1980-82 had a significantly increased mean Mental Development Index (MDI) on the Bayley Scales compared with the sub-group of survivors born in 1968-70 but there was also a significant improvement in mean MDI over time for a group of normal-birthweight children. No improvement of MDI scores of VLBW survivors in the 1980-82 cohort could be attributed solely to perinatal care. The two-year-old VLBW children in the 1980-82 cohort had similar rates of sensorineural impairments, disabilities and mean MDI to those who would have survived with the care available in 1966-70. It is concluded that survival of VLBW infants has improved in recent times but that neurodevelopmental outcome still lags behind that of normal-birthweight peers.