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Prospective study of New Zealand very low birthweight infants: outcome at 7-8 years
B A Darlow1, L J Horwood, N Mogridge
1Department of Paediatrics, Christchurch School of Medicine, Christchurch Hospital, New Zealand.
Insights
This study followed very low birthweight (VLBW) infants born in New Zealand in 1986 to assess long-term outcomes. While survival rates were comparable to other populations, a significant portion experienced mild to severe disabilities, including poor performance on cognitive tests.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Public Health
Background:
- Very low birthweight (VLBW) infants face increased risks for mortality and long-term neurodevelopmental challenges.
- Understanding the long-term outcomes of VLBW infants is crucial for improving neonatal care and support services.
Purpose of the Study:
- To evaluate the survival rates and sensorineural outcomes at 7-8 years of age in a national cohort of VLBW infants born in New Zealand in 1986.
- To identify the prevalence of disabilities and cognitive impairments in this cohort.
Main Methods:
- A prospective study enrolled all VLBW infants admitted to New Zealand neonatal units in 1986.
- Surviving infants were assessed at home between 7-8 years, including parental questionnaires, visual assessments (photorefraction), and cognitive testing (WISC-R).
Main Results:
- Of 413 VLBW infants, 298 (96% of NZ survivors) were assessed. 5.0% had severe, 4.7% moderate, and 15.4% mild disabilities.
- Rates of blindness (2.7%), deafness (1.3%), cerebral palsy (5.7%), and WISC-R scores >1 SD below mean (20.8%) were reported.
- No significant difference in outcomes was found between birthweight groups (<1000g vs. 1000-1499g).
Conclusions:
- Long-term survival and disability rates for this New Zealand VLBW cohort are comparable to international data.
- A notable proportion of VLBW survivors exhibited poor performance on cognitive assessments, potentially linked to attention and visual-motor integration issues.
Objective:
To determine the survival and sensorineural outcome at 7-8 years in very low birthweight (VLBW) infants born in New Zealand in 1986.
Methodology:
In 1986 all VLBW New Zealand infants admitted to neonatal units were enrolled in a prospective study of acute retinopathy of prematurity. Surviving infants were traced and were assessed at a home visit. Parents were asked a comprehensive questionnaire, and children underwent a visual assessment including photorefraction and were tested with the Revised Wechsler Intelligence Scale for Children (WISC-R).
Results:
Four hundred and thirteen VLBW infants were admitted to neonatal units in 1986, 338 (81.8%) surviving to discharge, 12 children died after discharge, 17 were traced to overseas, seven declined to participate and four were untraced, leaving 298 (96% survivors resident in New Zealand) who were assessed at a mean age of 7.6 (+/- 0.4 years, 15 children (5.0%) had severe disability, 14 (4.7%) moderate disability, and 46 (15.4%) mild disability. Blindness (vision worse than 6/60) occurred in eight children (2.7%), deafness requiring aids in four (1.3%), any form of cerebral palsy in 17 (5.7%), and an JQ score on the WISC-R > 1 SD below the mean in 62 (20.8%). There was no significant difference in outcome for children with birthweight < 1000 g and 1000-1499 g.
Conclusions:
Long-term (7-8 year) survival and disability rates in this national cohort of VLBW infants is comparable with that reported from other populations. Although a majority of children have no disability a sizeable proportion do perform poorly on the WISC-R. This may relate in part to problems such as a short attention span and poor visual-motor integration.