Outcome of Very Low Birthweight or Very Preterm Infants with Special Consideration of Perinatal Events

  • A. Stewart
  • P. Hope

Abstract

Preterm birth with a birthweight below 1500 g (very low birthweight — VLBW) is still an important perinatal complication, although reports from France of reductions in prevalence are encouraging (e.g. Papiernik et al. 1985). On average in “developed” countries, fewer than 2% of live babies born weigh less than 1500 g, but these infants still account for a large proportion of deaths in the early weeks of life. For example, in the United Kingdom, although only 0.9% of live births weighed < 1500 g in 1984, 48% of infants who died in the 1st week and 44% of those in the 1st month were of this low birthweight. This alone indicates that these pregnancies represent a major part of the perinatal workload, particularly for the staff of neonatal intensive care units. Estimates of the contribution from VLBW infants to childhood morbidity and disability are difficult to find. Alberman (1982) made some calculations, based on prevailing prevalence rates for various impairments and disabilities in the United Kingdom and estimated that VLBW infants accounted for about 1.9% of the major disabilities diagnosed in childhood in any 1 year in the United Kingdom, and she speculated that these infants probably contributed an even smaller proportion (0.8%) to the total of minor problems. More recently, there have been suggestions that VLBW infants, particularly those who weigh < 1000 g (extremely low birthweight — ELBW), continue to be major users of health care services right through the 1st year of life. For example, hospital admissions for respiratory infections or repair of hernias have been reported to be much more frequent among these infants, although actual estimates of the effects of these needs on services are not generally available. We should like to review reports on the current outcome of VLBW infants and to discuss a little information concerning the relationship between outcome and perinatal events which has resulted from prospective ultrasound (US) brain scan studies in the past 5 years.

Keywords

Neurol Peri Pneumothorax Blindness Preven 

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References

  1. Alberman E (1982) The epidemiology of congenital defects: a pragmatic approach. In: Adinolfi M, Benson P, Giannelli F, Seller M (eds) Paediatric research: a genetic approach. Spastics international medical publications. Heinemann, London, chapter 1, p 1.Google Scholar
  2. Alberman E, Benson J, McDonald A (1982) Cerebral palsy and severe educational subnormality in children with a birthweight of 41bs or less: a comparison of births in 1951-1953 and 1970-1973. Lancet I: 606–608.CrossRefGoogle Scholar
  3. Alden ER, Mandelkorn T, Woodrum DE, Wennberg RP, Parks CR, Hodson WA (1972) Morbidity and mortality of infants weighing less than 1000 g in an intensive care nursery. Pediatrics 50: 40–49.PubMedGoogle Scholar
  4. Amiel-Tison C (1986) Les nouveau-nés pesant 500 a 999 g. In: Encyclopedie Medicochirurgicale, 5114 L 20, Les Editions Techniques, Paris.Google Scholar
  5. Bryan H (1985) Chronic lung disease in premature infants. In: Beard RW, Sharp F (eds) Pre-term labour and its consequences. Royal College of Obstetricians and Gynaecologists, London. Perinatology, Ithaca, pp 365–371.Google Scholar
  6. Calâme A, Ducret J, Jaunin L, Plancherel (1983) High risk appropriate for gestational age (AGA) and small for gestational age (SGA) pre-term infants. Helv Paediatr Acta 38: 39–50.PubMedGoogle Scholar
  7. Cooke RWI (1981) Factors associated with periventricular haemorrhage in very low birth-weight infants. Arch Dis Child 56: 425–431.PubMedCrossRefGoogle Scholar
  8. Dunn PM (1985) Fetal viability: a perinatal viewpoint. In: Beard RW, Sharp F (eds) Pre-term labour and its consequences. Royal College of Obstetricians and Gynaecologists, London. Perinatology, Ithaca, pp 295–301.Google Scholar
  9. Dykes FD, Lazzara A, Ahmann P, Blumenstein B, Schwartz J, Brann AW (1980) Intraventricular haemorrhage: a prospective evaluation of etiopathogenesis. Pediatrics 66: 42–49.PubMedGoogle Scholar
  10. Hack M, Fanaroff A, Merkatz IR (1979) The low birth weight infant — evolution of a changing outlook. N Engl J Med 301: 1162–1166.PubMedCrossRefGoogle Scholar
  11. Hagberg B, Hagberg G, Olow I (1984) The changing panorama of cerebral palsy in Sweden 1954-70. IV. Epidemiological trends 1959-78. Acta Paediatr Scand 73: 433–440.PubMedCrossRefGoogle Scholar
  12. Hamilton PA, Hope PL, Cady EB, Delpy DT, Wyatt JS, Reynolds EOR (1986) Impaired energy metabolism in brains of newborn infants with increased echo-densities. Lancet I: 1242–1246.CrossRefGoogle Scholar
  13. Horwood SP, Boyle MH, Torrance GW, Sinclair JC (1982) Mortality and morbidity of 500-1499 gram birth weight infants live-born to residents of a defined geographic region before and after neonatal intensive care. Pediatrics 69: 613–620.PubMedGoogle Scholar
  14. Jurgens-Van Der Zee AD, Bierman-Van Eedenburg MEC, Fidler VJ, Olinga AA, Visch JH, Towen BCL, Huisjes HJ (1979) Pre-term birth, growth retardation and acidenda in relation to neurological abnormality of the newborn. Early Hum Dev 3: 141–154.PubMedCrossRefGoogle Scholar
  15. Klein N, Hack M, Gallagher J, Fanaroff A (1985) Pre-school performance of children with normal intelligence who were very low birth weight infants. Pediatrics 75: 531–537.PubMedGoogle Scholar
  16. Koops BL, Morgan LJ, Battaglia FC (1982) Neonatal mortality risk in relation to birth weight and gestational age: update. J Pediatr 101: 969–977.PubMedCrossRefGoogle Scholar
  17. Lipscomb AP, Thorburn RJ, Reynolds EOR, Stewart AL, Blackwell RJ, Cusick G, Whitehead MD (1981) Pneumothorax and cerebral haemorrhage in pre-term infants. Lancet I: 414–416.CrossRefGoogle Scholar
  18. Lloyd BW (1984) Outcome of very-low-birth weight babies from Wolverhampton. Lancet II: 739–741.CrossRefGoogle Scholar
  19. McCormick MC (1985) The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med 312: 82–90.PubMedCrossRefGoogle Scholar
  20. McDonald A (1982) Is the outcome of very low birth weight improving? In: Adinolfi M, Benson P, Giannelli F, Seller M (eds) Paediatric research: a genetic approach. Spastics international medical publications. Heinemann, London, chapter 2, p 13.Google Scholar
  21. Orgill AA, Astbury J, Bajuk B, Yu VYH (1982) Early development of infants 1000 g or less at birth. Arch Dis Child 57: 823–827.PubMedCrossRefGoogle Scholar
  22. Paneth N, Kiely JL, Wallenstein S, Marcus M, Pakter J, Susser M (1982) Newborn intensive care and neonatal mortality in low-birth-weight infants. N Engl J Med 307: 149–155.PubMedCrossRefGoogle Scholar
  23. Papiernik E, Bouyer J, Dreyfus J (1985) Risk factors for pre-term births and results of a prevention policy. The Haguenau perinatal study 1971-1982. In: Beard RW, Sharp F (eds) Pre-term labour and its consequences. Royal College of Obstetricians and Gynaecologists, London. Perinatology, Ithaca, pp 15–24.Google Scholar
  24. Perlman JM, Goodman S, Krevsser KL, Volpe JJ (1985) Reduction in intraventricular hemorrhage by elimination of fluctuating cerebral blood-flow velocity in pre-term infants with respiratory distress syndrome. N Engl J Med 312: 1353–1357.PubMedCrossRefGoogle Scholar
  25. Powell TG, Pharoah POD, Cooke RWI (1986) Survival and morbidity in a geographically defined population of low birth weight infants. Lancet I: 539–543.CrossRefGoogle Scholar
  26. Rantakallio P, Von Wendt L (1985) Prognosis for low birth weight infants up to the age of fourteen years, a population study. Dev Med Child Neurol 27: 655–663.PubMedCrossRefGoogle Scholar
  27. Saigal S, Rosenbaum P, Stoskoff B, Milner R (1982) Follow-up of infants 501-1500 g birth weight delivered to residents of a geographically defined region with perinatal intensive care facilities. J Pediatr 100: 606–613.PubMedCrossRefGoogle Scholar
  28. Saigal S, Rosenbaum P, Stoskoff B, Sinclair JC (1984) Outcome of infants 501-1000 gm birth weight delivered to residents of the McMaster Health Region. J Pediatr 105: 969–976.PubMedCrossRefGoogle Scholar
  29. Shapiro S, McCormick MC, Starfield BH, Crawley B (1983) Changes in infant morbidity associated with decreases in neonatal mortality. Pediatrics 72: 408–415.PubMedGoogle Scholar
  30. Stewart A, Turcan D, Rawlings G, Hart S, Gregory S (1978) Outcome for infants at high risk of major handicap. In: Elliott K, O’Connor M (eds) Major mental handicap: methods and costs of prevention. Ciba foundation symposium no. 59 (new series). Elsevier, Amsterdam, pp 151–164.Google Scholar
  31. Stewart A, Reynolds EOR, Lipscomb AP (1981) Outcome for infants of very low birth weight: survey of world literature. Lancet I: 1038–1041.CrossRefGoogle Scholar
  32. Thorburn RJ, Lipscomb AP, Stewart AL, Reynolds EOR, Hope PL (1982) Timing and antecedents of periventricular haemorrhage in very pre-term infants. Early Hum Dev 9: 221–238.CrossRefGoogle Scholar
  33. Towen BCL, Huisjes HJ, Jurgens-Van Der Zee AD, Bierman-van Eendenburg MEC, Smrkovsky M, Olinga AA (1980) Obstetrical condition and neonatal neurological morbidity. An analysis with the help of the optimality concept. Early Hum Dev 4: 207–228.CrossRefGoogle Scholar
  34. Zuspan FP, Christian CD (eds) (1983) Reid’s controversy in obstetrics and gynaecology — III. Saunders, Philadelphia.Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • A. Stewart
  • P. Hope

There are no affiliations available

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