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Extremely low-birth-weight infants less than 901 g: development and behaviour after 4 years of life
K Stjernqvist1, N W Svenningsen
1Department of Paediatrics, University Hospital, Lund, Sweden.
Insights
Extremely low-birth-weight (ELBW) children show some developmental delays by age 4 but most maintain a good quality of life. Early interventions may be crucial for optimizing outcomes in these high-risk infants.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Pediatric Neurology
Background:
- Extremely low-birth-weight (ELBW) infants (500-900g) face significant health and developmental challenges.
- Long-term follow-up is essential to evaluate the comprehensive outcomes of ELBW survivors.
Purpose of the Study:
- To compare the growth, health, development, and quality of life of ELBW children with full-term controls at 4 years of age.
- To identify specific areas of delay and potential risk factors in ELBW children.
Main Methods:
- Prospective, control study comparing 20 ELBW infants with 20 full-term infants at 4 years of age.
- Assessment included growth parameters, neurological examination, cognitive development (Griffiths Mental Development Scale), and behavioral evaluations.
Main Results:
- 20% of ELBW children had major neurological disorders identified by 1 year.
- 85% of ELBW children had cognitive development within the normal range but lower than controls, with notable delays in locomotor and visual-motor skills.
- 40% of ELBW children experienced increased healthcare utilization due to recurrent respiratory infections or neurological issues.
- Increased hyperactivity and concentration difficulties were observed in the ELBW group.
Conclusions:
- While most ELBW children demonstrate good quality of life by age 4, specific developmental deficits persist.
- Neurological and respiratory complications significantly impact health outcomes and healthcare needs.
- Comprehensive, long-term monitoring is vital for ELBW survivors to address developmental trajectories and ensure optimal well-being.
Abstract:
In a long-term, prospective, control study, 20 extremely low-birth-weight (ELBW) infants with birth weights between 500 and 900 g (mean 755 (SD 109) g) and gestational ages between 24 and 30 weeks (mean 26.2 (SD 1.8) weeks) were compared with 20 full-term infants at 4 years of age for growth, health, development and quality of life. Four of 20 (20%) ELBW children had major neurological disorders, which were all identified at the 1-year assessment. Seventeen (85%) ELBW children had cognitive development, assessed with the Griffiths mental development scale, within the normal range for age but lower than for full-term controls. The greatest deviations between ELBW and full-term children were found in locomotor and visual-motor integration functions. Eight ELBW children in all (40%), four with recurrent respiratory tract infections after neonatal mechanical ventilation and the four children with major neurological disorders had a higher rate of visits to physicians and hospital admissions. The behavioural symptom interview showed an increased rate of hyperactivity and difficulties in concentrating but not of general behavioural deviations in the ELBW group. Only by school age can all aspects of an extremely early birth be evaluated, but at 4 years of age, 85% of the ELBW children in our group had a good quality of life according to Scheffzek's categorizations.