Decreased disability rate among 3-year-old survivors weighing 501 to 1000 grams at birth and born to residents of a geographically defined region from 1981 to 1984 compared with 1977 to 1980

doi:10.1016/S0022-3476(89)80150-7

The Journal of Pediatrics

Volume 114, Issue 5, May 1989, Pages 839-846

https://doi.org/10.1016/S0022-3476(89)80150-7 Get rights and content

In this article we report the survival and morbidity rates for all live-born infants weighing 501 to 1000 gram at birth and born to residents of a defined geographic region from 1977 to 1980 (n=255) compared with 1981 to 1984 (n=266). During these periods, there were no changes in the proportion of infants delivered at the tertiary care center or community hospitals (171/84 vs 194/72); use of the tertiary care center increased only slightly, from 84% to 91%; and changes in neonatal management were mainly in improvements in diagnostic and monitoring techniques. When infants were grouped according to birth weights in 100 gm increments, survival improved significantly only for infants weighing between 501 and 600 gm at birth (2% vs 20% p<0.001). There were no differences in the overall survival rates to hospital discharge (46% vs 48%). The prevalence of neurosensory impairments was 24% in period 1 and 17% in period 2. There was a significant improvement in the proportion of infants considered to have disabilities by a functional classification assigned at 3 years corrected age (50% vs 27%, p<0.001), but only for infants weighing more than 800 gm at birth (49% vs 22%, p<0.001). Infants delivered at the community hospitals had a higher prevalence of neurosensory impairments compared with infants delivered at the tertiary care center (period 1, 35% vs 21%, not significant; period 2, 37% vs 14%, p<0.05). These data are encouraging; further efforts should be directed toward assessing which, if any, components of perinatal care are contributing to the improvement in morbidity rates.

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To examine potential long-term effects of extremely low birth weight (ELBW; ≤ 1000 g) on adult brain structure, brain function, and cognitive-behavioral performance.
A subset of survivors from the prospectively-followed McMaster ELBW Cohort (n = 23, M_BW = 816 g) and their peers born at normal birth weight (NBW; ≥ 2500 g; n = 14, M_BW = 3361 g) provided T1-weighted magnetic resonance imaging (MRI) brain scans, resting electroencephalographic (EEG) recordings, and behavioral responses to a face-processing task in their early thirties.
Visual discrimination accuracy for human faces, resting EEG alpha power, and long-distance alpha coherence were lower in ELBW survivors than NBW adults, and volumes of white matter hypointensities (WMH) were higher. Across groups, face-processing performance was correlated positively with posterior EEG spectral power and long-distance alpha and theta coherence, and negatively with WMH. The associations between face-processing scores and parietal alpha power and theta coherence were reduced after adjustment for WMH.
Electrocortical activity, brain functional connectivity, and higher-order processing ability may be negatively affected by WMH burden, which is greater in adults born extremely preterm.
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Very premature infants born in the last century following the early days of post-neonatal intensive care have demonstrated an array of physical, emotional, and mental health problems as they approach their third and fourth decades. These outcomes have been well documented by several international investigators. However, there is a paucity of information on the personal perspectives of these individuals with regard to their own quality of life, their hopes and their fears. This article will focus on the objective information from the published literature and how it differs from the personal perspectives of former very premature infants.
Health-Related Quality of Life Trajectories of Extremely Low Birth Weight Survivors into Adulthood
2016, Journal of Pediatrics
Citation Excerpt :
A total of 179 ELBW survivors (birth weight 501-1000 g), born to residents of central-west Ontario (Canada) from 1977 to 1982, and followed longitudinally from birth were eligible for the study.25
To compare the health-related quality of life (HRQL) trajectories of a regional cohort of extremely low birth weight (ELBW, <1000 g) survivors (births from 1977 to 1982) and a group of normal birth weight (NBW) controls, at 3 ages: 12-16 years, 22-26 years, and 29-36 years, spanning over 20 years. We hypothesized that the HRQL of the ELBW cohort would be significantly compromised compared with their NBW peers, and that neurosensory impairments (NSI) would have an additional negative effect.
We used the Health Utilities Index Mark 3, in which health status was self-assessed and utility scores were derived from community preferences; multilevel modeling was used to delineate trajectories of HRQL among ELBW survivors with (n = 37) and without NSI (n = 116), and NBW controls (n = 137).
Adjusting for participant sex and socioeconomic status at age 8 years, ELBW survivors with NSI had consistently lower HRQL compared with both ELBW survivors without NSI and NBW controls, from adolescence through to adulthood (β = −0.264; P < .001). ELBW survivors without NSI also had significantly lower HRQL compared with NBW controls (β = −0.092; P < .01). At all ages, differences seen in the Health Utilities Index Mark 3 scores between ELBW participants and NBW controls were clinically important, though there was no differential rate of decline between the 2 groups.
ELBW survivors manifest meaningfully poorer HRQL from their early teens through their mid-30s. Individuals with NSI appear to represent a distinct group of ELBW survivors with substantially lower HRQL at all ages. Information on HRQL can be helpful in prioritizing research and intervention strategies.
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This review is presented in three segments: (1) important background concepts, (2) recent reports from regional geographically defined cohorts, and (3) prognosis research from the National Institutes of Health Neonatal Research Network. Extending the use of intensive care to newborns of lower gestational ages will unavoidably result in a higher proportion and a higher absolute number of survivors with morbidity, unless other changes in practice offset the increased risk associated with decreasing gestational age. In geographically defined cohort studies, the proportion of periviable newborns delivered in perinatal centers and the practices around foregoing and withdrawing intensive care are two important determinants of outcomes following periviable birth. It is much easier to quantify the effect of the former than the latter. Decisions regarding comfort care vs. intensive are frequently based on gestational age as the sole predictor variable, although multiple factors can be readily used to more accurately assess the benefits and burdens of intensive care and facilitate better informed parental counseling and decision making.
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Citation Excerpt :
Although the group also noted an increase in the absolute number of children with CP, the number of survivors free of CP rose even more, from 39 per year in 1979–1980 to 150 per year in 1997.93 Other regional studies have reported increases in ‘quality-adjusted life-years’ and decreases in ‘functional disabilities’ for ELBW survivors, lending further evidence to the effectiveness of neonatal intensive care.90,94 Data on the efficiency of neonatal intensive care has been evaluated in terms of cost/effectiveness ratios.
Advances in perinatal interventions over the past three decades, such as antenatal steroid therapy, ventilator techniques, surfactant therapy, and enhanced nutrition have resulted in a dramatic improvement in the survival of very low birth weight (VLBW) infants. Simultaneously, other advances in reproductive technology procedures have resulted in greater numbers of preterm and multiple births. These extremely premature births account for the vast majority of infant mortality and morbidity in the developed world. Despite the innovative interventions, VLBW infants remain at substantial risk for a wide spectrum of long-term morbidity including cerebral palsy (CP), mental retardation, developmental delay, school problems, behavioral issues, growth failure, and overall poor health status. Recently, ethical concerns have been expressed that improved survival rates for the most immature infants may result in increased rates of disability with substantial resource utilization and declining quality of life for the survivors. This chapter critically evaluates the available neurodevelopmental and health outcomes of very premature infants from the developed world in an attempt to determine if there is evidence that long-term outcomes have improved with neonatal intensive care. Studies on the rates of neurodevelopmental impairment including CP, early childhood and school age functional problems, and special health care issues are surveyed in order to evaluate changes over time and provide an assessment of the success of neonatal intensive care over the past three decades.
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2007, Paediatrics and Child Health
Since the Department of Health published its report into Neonatal Intensive Care Services, 22 Managed Clinical Neonatal Networks have been established in England. Depending on local commissioning arrangements and support, they have been variously effective at creating a strategy for the development of neonatal services in geographical areas based on around 15,000–20,000 deliveries in each. The major constraints are funding, availability of information technology and sign-up on behalf of constituent hospitals. The continuing re-organisation of the NHS has mitigated against a sustained period of development of neonatal services. Networks have the potential to deliver significant improvements in neonatal outcomes in the UK.

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⁺: Presented at the Society for Pediatric Research, Washington, D.C., May 1988, and the Canadian Pediatric Society, Calgary, Alberta, Canada, July 1988.

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Decreased disability rate among 3-year-old survivors weighing 501 to 1000 grams at birth and born to residents of a geographically defined region from 1981 to 1984 compared with 1977 to 1980+

Am J Obstet Gynecol

J Pediatr

J Pediatr

J Pediatr

Am J Obstet Gynecol

J Pediatr

J Pediatr

J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Lancet

Lancet

Clin Perinatol

J Pediatr

J Pediatr

Mortality and morbidity in infants less than 1,001 grams birth weight

Pediatrics

Early development of infants 1000 g or less at birth

Arch Dis Child

Infants with birth weights less than 1,001 g: survival, growth, and development

Am J Dis Child

Is intensive care justified for infants weighing less than 801 gm at birth

J Pediatr

Growth and development of infants weighing less than 800 grams at birth

Pediatrics

Mortality and follow-up data for neonates weighing 500 to 800 g at birth

Am J Dis Child

Changes in the delivery room care of the extremely small infant (<750 g): effects on morbidity and outcome

N Engl J Med

Survival and short-term morbidity of the premature neonate

Obstet Gynecol