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Improving outcome for Western Australian infants with birthweights 500-999 g
N P French1, T S Parry, S Evans
1King Edward Memorial Hospital, Perth, WA.
Insights
Survival rates for extremely low birthweight infants improved significantly between 1980-1987 without increasing disability. This study tracked outcomes for these vulnerable newborns, showing positive trends in neurodevelopmental assessments.
Area of Science:
- Neonatalogy and Perinatal Medicine
- Developmental Pediatrics
- Public Health
Background:
- Extremely low birthweight (ELBW) infants (500-999 g) face significant risks for mortality and long-term disability.
- Assessing trends in ELBW infant outcomes is crucial for evaluating healthcare advancements and identifying areas for improvement.
Purpose of the Study:
- To evaluate changes in survival rates and neurodevelopmental disability among liveborn ELBW infants in Western Australia from 1980 to 1987.
- To compare outcomes between two distinct periods: 1980-1983 (P1) and 1984-1987 (P2).
Main Methods:
- A cohort study design was employed, analyzing data from 586 ELBW infants born in Western Australia between 1980 and 1987.
- Key variables included birthweight, place of birth, survival status, age at death, and neurosensory examination findings using standardized assessments.
Main Results:
- Overall survival for ELBW infants increased from 35% to 43%, with survival doubling in infants below 800 g (14% to 29%).
- Disability rates remained stable for infants under 800 g but decreased significantly for those between 800-999 g (24% to 13%).
- Survival free of disability improved from 26% to 34% over the study period.
Conclusions:
- Improved survival rates for ELBW infants were achieved without a concurrent increase in the rate or severity of disability.
- These findings suggest advancements in neonatal care contributed to better outcomes for ELBW infants during this period.
Objective:
To assess changes in survival and disability in liveborn extremely low birthweight infants (500-999 g) in Western Australia, 1980-1987.
Design:
Cohort study comparing two periods, 1980-1983 (P1) and 1984-1987 (P2).
Participants:
All 586 liveborn extremely low birthweight infants in WA in 1980-1987 (266 in P1, 320 in P2).
Main Variables Examined:
Birthweight, place of birth, age at death, neurosensory examination findings and scores on the Griffiths Mental Development Scales or other standardised test results.
Results:
482/586 infants (82%) were born at King Edward Memorial Hospital (KEMH), a level III referral centre, and a further 4% were transferred there after birth. The proportion born at KEMH increased from 78% in P1 to 86% in P2. Survival increased from 35% to 43% overall. In those below 800 g birthweight, survival doubled from 14% to 29%. There was no change in the age at death for non-survivors. Follow-up information was known for 222 of the 229 survivors at median ages of 46 months (P1) and 43 months (P2). Disability rates in infants below 800 g birthweight remained static (P1, 26%; P2, 28%), but fell in those of 800-999 g birthweight from 24% to 13%. Overall, survival free of disability increased from 26% to 34%.
Conclusion:
Increased survival rates occurred without any increase in the rate or severity of disability in survivors.