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Neurosensory outcome at 5 years and extremely low birthweight. The Victorian Infant Collaborative Study Group
Insights
Neurodevelopmental outcomes for extremely low birthweight (ELBW) children are more stable by age 5. Improved survival rates for ELBW infants have not increased the number of severely disabled children.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Public Health
Background:
- Improving survival rates for extremely low birthweight (ELBW) infants necessitate evaluating long-term neurodevelopmental outcomes.
- Previous studies suggest neurosensory assessment at 2 years may not fully capture long-term stability.
Purpose of the Study:
- To assess the stability of neurodevelopmental outcomes in extremely low birthweight (ELBW) children from 2 to 5 years of age.
- To determine if increased ELBW survival rates correlate with an increase in severe neurosensory disabilities.
Main Methods:
- A cohort study compared ELBW survivors born in Victoria during 1979-80 and 1985-7.
- Neurosensory impairments and disabilities were assessed at 2 and 5 years of age.
Main Results:
- Among 1985-7 ELBW survivors, 5.7% had severe neurosensory disability at 5 years, a decrease from 12.4% in the 1979-80 cohort.
- Significant reductions in hearing and intellectual impairment were observed in the later cohort.
- Changes in neurosensory classification were often linked to psychological test results.
Conclusions:
- Neurodevelopmental outcomes for ELBW infants are not fully established by 2 years of age.
- Increased survival of ELBW infants in the mid-1980s did not lead to a greater number of severely disabled children at 5 years.
- The findings indicate a positive trend in neurodevelopmental outcomes for ELBW survivors.
Objective:
To establish the stability of neurosensory outcome at 5 years of age compared with 2 years of age, and to determine whether the improving survival rate of extremely low birthweight (ELBW) (500-999 g) children has been accompanied by an increase in the number of severely impaired and disabled children in the community.
Methods:
A geographically determined cohort study was made of consecutive ELBW survivors born in the state of Victoria during 1985-7, and during 1979-80, inclusive. Rates of neurosensory impairments and disabilities at 2 and 5 or more years of age were measured.
Results:
Of 212 children surviving to 5 years of age born during 1985-7, 211 (99.5%) had been assessed at 2 years of age, and 209 (98.6%) were assessed at 5 or more years of age. Of the 208 children seen at both 2 and 5 years, 32 children had deteriorated, 23 children had improved, and 153 were unchanged, compared with their 2 year assessment. The major reason for a change in classification was an alteration in psychological test results. Compared with ELBW children born in 1979-80, those born in 1985-7 had significant reductions in hearing and intellectual impairment. The rate of severe neurosensory disability in the 1985-7 cohort was 5.7% compared with 12.4% in children born in 1979-80.
Conclusions:
The age of 2 is too early to be sure of neurosensory outcome in ELBW infants. The additional survivors born in the mid 1980s, compared with the late 1970s, are free of severe neurosensory disability at 5 years of age, with no increase in the absolute number of ELBW children surviving with severe neurosensory disability.