Collaborative study of very-low-birth-weight infants. Correlation of handicap with risk factors

Two large maternity services studied consecutive inborn infants (birth weight range, 500 to 1,500 g) born between 1977 and 1978. The multidisciplinary team members used identical assessment methods and documentation. Of 259 long-term survivors, 252 (97.3%) were seen at 2 years of age. Survival rates for hospitals 1 and 2 were 68.5% and 69.0%, respectively. Cerebral palsy rates for hospitals 1 and 2 were 11.8% and 11.2%, respectively. Major handicaps (cerebral palsy, mental developmental index [MDI] on the Bayley scales less than 69, epilepsy, deafness, or blindness) occurred in 30 (18.6%) and 17 (17.3%) of hospitals 1 and 2 survivors, respectively. Both cerebral palsy and developmental delay (MDI below 75 without severe or moderate cerebral palsy) were significantly correlated with a number of perinatal variables, but none were common to the two hospitals. Of the 30 children with cerebral palsy, 15 (50%) were not ventilated, and 28 (93%) had a five-minute Apgar score greater than 4; there was no indication that selective treatment to prevent cerebral palsy was possible.