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Outcome of very low birth weight infants in industrialized countries: 1947-1987
K S Lee1, B I Kim, B Khoshnood
1Department of Pediatrics, Pritzker School of Medicine, University of Chicago, IL, USA.
Insights
Improved neonatal intensive care has increased survival for very low birth weight (VLBW) infants. Despite concerns, the overall prevalence of handicapping conditions in VLBW children has decreased significantly over time.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Public Health
Background:
- Neonatal intensive care has improved survival rates for very low birth weight (VLBW) infants (<1,500 g).
- The impact of improved survival on the prevalence of handicapping conditions in VLBW children remains unclear.
- Data on VLBW infant outcomes from industrialized nations between 1947 and 1987 are available.
Purpose of the Study:
- To determine if the survival of VLBW infants has been accompanied by an increase or decrease in handicapping conditions.
- To analyze trends in the prevalence of handicapping conditions among VLBW survivors over several decades.
Main Methods:
- A meta-analysis of 32 developmental studies involving VLBW infants.
- Inclusion of studies from industrialized countries published between 1947 and 1987.
- Analysis of outcome data focusing on survival rates and the presence of major handicapping conditions.
Main Results:
- The proportion of VLBW infants surviving with an intact outcome increased significantly from 147 to 498 per 1,000 live births between 1947-1965 and 1980-1987.
- The prevalence of major handicapping conditions increased among the subset of VLBW infants weighing <1,000 g.
- Overall prevalence of major handicapping conditions among all VLBW children decreased from 147 to 45 per 1,000 live births (p=0.02).
Conclusions:
- Improved survival rates for VLBW infants have not led to a rise in the overall prevalence of handicapping conditions.
- The meta-analysis suggests a decrease in the prevalence of major handicapping conditions in the VLBW population.
- Advances in neonatal care have positively impacted long-term outcomes for VLBW infants.
Abstract:
Neonatal intensive care has led to a progressive improvement in the survival of very low birth weight (VLBW, < 1,500 g) infants. However, it has not been established whether there has been a simultaneous increase or decrease in the prevalence of handicapping conditions in this group of children. To explore this question, a meta-analysis was performed using outcome data of 32 developmental studies of VLBW infants born in industrialized countries between 1947 and 1987. The authors' results show that the proportion of VLBW infants who survived and had an intact outcome progressively increased between 1947 and 1987--from 147 per 1,000 live births in the period 1947-1965 to 498 per 1,000 in the period 1980-1987 (p < 0.01). The prevalence of major handicapping conditions for the subset of VLBW infants who weighed < 1,000 g at birth increased, resulting from the increasing survival rates. However, the prevalence of major handicapping conditions among all children with VLBW decreased from 147 per 1,000 live births in 1947-1965 to 45 per 1,000 in 1980-1987 (p = 0.02). The authors' meta-analysis suggests that improved survival of VLBW infants has not been accompanied by an increase, but more likely a decrease, in the prevalence of handicapping conditions in this birth weight group.