Outcomes of extremely-low-birth-weight infants between 1982 and 1988

Article Abstract:

Clinical outcomes were investigated for a population of 227 low-birth-weight infants (weighing under 750 g or approximately 1 lb 10 oz) and for 396 infants with a gestational age of less than 28 weeks regardless of weight. The groups were divided into babies born during two periods, July 1982 to June 1985 and July 1985 to June 1988, to investigate changes in medical treatment and clinical outcome between both periods. Over time the aggressiveness of intervention was found to have significantly increased, but there was no measurable difference in the outcomes of the infants. The mean time before death for infants placed in neonatal intensive care increased from 73 to 880 hours, but the number of babies surviving did not change. Only about 20 percent of those infants weighing less than 750 grams survived, and those that did survive had a significant rate of neurological impairment when measured at 20 months of age. When viewed by gestational age only 8 percent of babies born before the 23rd week of pregnancy survived; at 24 weeks 16 percent, and at 27 weeks 72 percent of all babies lived. Despite an increase in the number of cesarean sections performed, and intubations and mechanical ventilation, in which an oxygen tube is inserted into the baby's trachea, babies born under 25 weeks or with birth weights of 750 g or less have a very poor chance of survival. A fetus born at 25 weeks or more with a birth weight of 700 g has an even chance of survival. Whenever medically possible, efforts should be made to prolong pregnancy up to or beyond this critical juncture. Among premature and very low-birth-weight survivors there is a high level of chronic impairment including lung diseases, and neurological, eye, and gastrointestinal problems.

Evaluation, Patient outcomes, Mortality, Complications and side effects, Neonatal intensive care, Infant mortality, Gestational age

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Effect of very low birth weight and subnormal head size on cognitive abilities at school age

Article Abstract:

Infants born with very low birth weights often exhibit poor growth during their first year of life. A previous report by the authors showed that very-low-birth-weight infants with smaller heads than normal at eight months had lower IQ scores at three years than normal children. This study examined the cognitive abilities of eight-year-old children who had very low birth weights and smaller head sizes than normal at eight months of age. A number of cognitive tests were performed on 249 children, who had been continually monitored and measured since birth. Thirty-three of the children had subnormal head sizes at eight months. The average results of the IQ tests were 95.6 and 94.2 for verbal and performance components, respectively. Normal IQ scores were achieved by 74 percent of the children; 19 percent had borderline scores; and 6 percent tested as mentally retarded. Scores were significantly lower for the 33 children with subnormal head circumferences at eight months (84.1 verbal and 82.1 performance) than for the 216 children who had normal head sizes at eight months (97.5 verbal and 95.9 performance). These differences were consistent on tests of language and speech abilities, and school performance. The relation between head size at eight months and IQ at eight years remained even when all subjects with neurologic problems were excluded. These results indicate that very-low-birth-weight infants who exhibit poor growth during their first eight months, as evidenced by subnormal head size, are more likely to score poorly on tests of cognitive ability at eight years than infants who have normal head sizes at eight months of age. (Consumer Summary produced by Reliance Medical Information, Inc.)

Statistics, Infants (Newborn), Newborn infants, Child development, Infant development, Cephalometry

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Periventricular leukomalacia -- prospects for prevention

Article Abstract:

The corticosteroid drug betamethasone appears to be effective in lowering the risk of periventricular leukomalacia in very premature babies. Periventricular leukomalacia is a brain disorder that occurs in premature babies and it is a risk factor for cerebral palsy. Corticosteroids are often given just before birth to pregnant women in premature labor in order to prevent lung disease in the baby. A 1999 study found that betamethasone lowered the risk of periventricular leukomalacia in premature babies but dexamethasone did not. Women in premature labor should also be given antibiotics, because uterine infection can also cause periventricular leukomalacia.

Health aspects, Editorial, Prevention, Diseases, Brain diseases, Betamethasone

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