Document Detail

Outcomes of children of extremely low birthweight and gestational age in the 1990's.
MedLine Citation:
PMID:  10088988     Owner:  NLM     Status:  MEDLINE    
Advances in perinatal care have improved the chances for survival of extremely low birthweight (< 800 g) and gestational age (< 26 weeks) infants. A review of the world literature and our own experience reveals that at 23 weeks gestation survival ranges from 2% to 35%. At 24 weeks gestation the range is 17% to 58%, and at 25 weeks gestation 35% to 85%. Differences in population descriptors, in the initiation and withdrawal of treatment and the duration of survival considered may account for the wide variations in the reported ranges of survival. Major neonatal morbidity increases with decreasing gestational age and birthweight. The rates of severe cerebral ultrasound abnormality range at 23 weeks gestation from 10% to 83%, at 24 weeks from 17% to 64% and at 25 weeks gestation from 10% to 22%. At 23 weeks gestation, chronic lung disease occurs in 57% to 70% of survivors, at 24 weeks in 33% to 89%, and at 25 weeks gestation in 16% to 71% of survivors. When compared to children born prior to the 1990's, the rates of neurodevelopmental disability have, in general, remained unchanged. Of 30 survivors reported at 23 weeks gestation nine (30%) are severely disabled. At 24 weeks gestation the rates of severe neurodevelopmental disability (including subnormal cognitive function, cerebral palsy, blindness and deafness) range from 17% to 45%, and at 25 weeks gestation 12% to 35% are similarly affected. In Cleveland, Ohio, we compared the outcomes of 114 children with birthweight 500-749 g born 1990-1992 to 112 infants born 1993-1995. Twenty month survival was similar (43% vs 38%). The use of antenatal and postnatal steroids increased (10% vs 54% and 43% vs 84%, respectively, P< 0.001), however the rates of chronic lung disease increased from 41% to 63% (P = 0.06). There was a significant increase in the rate of subnormal cognitive function at 20 months corrected age (20% vs 48%, P < 0.02) and a trend to an increase in the rate of cerebral palsy (10% vs 16%) and neurodevelopmental impairment. We conclude that, with current methods of care, the limits of viability have been reached. The continuing toll of major neonatal morbidity and neurodevelopmental handicap are of serious concern.
M Hack; A A Fanaroff
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Early human development     Volume:  53     ISSN:  0378-3782     ISO Abbreviation:  Early Hum. Dev.     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-05-06     Completed Date:  1999-05-06     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7708381     Medline TA:  Early Hum Dev     Country:  IRELAND    
Other Details:
Languages:  eng     Pagination:  193-218     Citation Subset:  IM    
Department of Pediatrics, Case Western Reserve University School of Medicine and University Hospitals of Cleveland, OH 44106-6010, USA.
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MeSH Terms
Brain Diseases / epidemiology
Chronic Disease
Gestational Age*
Infant Mortality
Infant, Newborn
Infant, Very Low Birth Weight*
Lung Diseases / epidemiology
Pulmonary Surfactants / therapeutic use
Steroids / therapeutic use
Survival Rate
Reg. No./Substance:
0/Pulmonary Surfactants; 0/Steroids

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