Eight-year outcome in infants with birth weight of 500 to 999 grams: Continuing regional study of 1979 and 1980 births

doi:10.1016/S0022-3476(05)80044-7

The Journal of Pediatrics

Volume 118, Issue 5, May 1991, Pages 761-767

https://doi.org/10.1016/S0022-3476(05)80044-7 Get rights and content

The outcome at a mean age of 8.3 years was determined for 88 of 89 surviving children with birth weights of 500 to 999 gm who were born in Victoria in 1979 and 1980; the condition of the untraced child, severely disabied at 5 years of age, was assumed to be unchanged at 8 years. Principal impairments in the children at 8 years of age were cerebral palsy 8 (9%); bilateral blindness 6 (6.7%) and poor vision in another 4 (4.5%); bilateral deafness requiring amplification 5 (5.6%); and epilepsy 2 (2.2%). The Full Scale score of the Weschier intelligence Scales for Children—Revised was available for 77 children: 5 scores (6.5%) were less than 71 (low IQ), and 9 (11.7%) were between 71 and 85 (borderline IQ). Severe disability in 16 children (18%) was due to severe cerebral palsy, bilateral blindness, or low IQ. Mild or moderate disability was present in another 18 children (20.2%) with borderline IQ, mild or moderate cerebral palsy, poor vision, deafness, or epilepsy. Significantly more outborn children (10/18, 55.6%) than inborn children (24/71, 33.8%) were disabled. Ten children required special schooling; reading accuracy or comprehension was at least 18 months behind chronologic age in 17 (23%) of 75 children in normal school who were tested. The 2-year assessment correctly estimated the category of disability at 8 years of age in 55 (62%), overestimated it in 24 (27%), and underestimated it in 10 (11%). For the 82 children also seen at 5 years age, the category of disability at 8 years of age was correctly identified in 69 children (84%), overestimated in 4 (5%), and underestimated in 9 (11%). Change in psychologic test scores was the principal reason for reclassifying children. We conclude that the 2-year assessment was valuable in the early identification of most of the severely disabled children, but developmental delay at 2 years of age did not always portend intellectual impairment at 8 years of age.

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Extreme preterm birth (EPB), which is defined by the World Health Organization (WHO) as birth before the 28th week of gestational age [1–3], is associated with significant morbidity and accounts for the majority of newborn deaths [4–8]. Preterm infants have a high risk of developing a wide array of complications, including cerebral palsy [9–11], developmental delay, sensory impairments (e.g., visual and auditory deficits) [12], school difficulties [13–17], and behavioral problems [18–20] both in childhood and adulthood [21]. Identifying pregnancies at risk for EPB and transferring care to centers with neonatal intensive care units (NICUs) can improve both short- and long-term outcomes for EPB infants [21–26].
Models for predicting preterm birth generally have focused on very preterm (28–32 weeks) and moderate to late preterm (32–37 weeks) settings. However, extreme preterm birth (EPB), before the 28th week of gestational age, accounts for the majority of newborn deaths. We investigated the extent to which deep learning models that consider temporal relations documented in electronic health records (EHRs) can predict EPB.
EHR data were subject to word embedding and a temporal deep learning model, in the form of recurrent neural networks (RNNs) to predict EPB. Due to the low prevalence of EPB, the models were trained on datasets where controls were undersampled to balance the case-control ratio. We then applied an ensemble approach to group the trained models to predict EPB in an evaluation setting with a nature EPB ratio. We evaluated the RNN ensemble models with 10 years of EHR data from 25,689 deliveries at Vanderbilt University Medical Center. We compared their performance with traditional machine learning models (logistical regression, support vector machine, gradient boosting) trained on the datasets with balanced and natural EPB ratio. Risk factors associated with EPB were identified using an adjusted odds ratio.
The RNN ensemble models trained on artificially balanced data achieved a higher AUC (0.827 vs. 0.744) and sensitivity (0.965 vs. 0.682) than those RNN models trained on the datasets with naturally imbalanced EPB ratio. In addition, the AUC (0.827) and sensitivity (0.965) of the RNN ensemble models were better than the AUC (0.777) and sensitivity (0.819) of the best baseline models trained on balanced data. Also, risk factors, including twin pregnancy, short cervical length, hypertensive disorder, systemic lupus erythematosus, and hydroxychloroquine sulfate, were found to be associated with EPB at a significant level.
Temporal deep learning can predict EPB up to 8 weeks earlier than its occurrence. Accurate prediction of EPB may allow healthcare organizations to allocate resources effectively and ensure patients receive appropriate care.
Predictive value of the Bayley Scales of Infant Development on development of very preterm/very low birth weight children: A meta-analysis
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A total of 16 studies met inclusion criteria. Eight studies investigated the BSID-I [13,15–20,29–32], seven studies investigated the BSID-II [11,12,14,21,22,33,34] and one study investigated the Bayley-III [29]. The final sample for meta-analysis contained a total of 1792 very preterm/VLBW children.
The Bayley Scales of Infant Development (BSID) is the most widely used measure to assess neurodevelopment of very preterm (gestational age ≤ 32 weeks) and very low birth weight (VLBW, ≤ 1500 g) infants in the first three years of life. This meta-analysis determines the predictive value of the Mental Developmental Index (MDI) and the Psychomotor Developmental Index (PDI)/Motor Composite, collectively referred to as Bayley motor scale, of the BSID-I, -II and Bayley-III for later cognitive and motor functioning in very preterm/VLBW children.
Cochrane Library, PubMed, PsychINFO and CINAHL were searched for English-language peer-reviewed studies published before March 2013. Studies were included if they reported odds ratios or correlations between the MDI or Bayley motor scale scores obtained in the first three years of life, and standardized cognitive or motor assessment obtained later in life in very preterm/VLBW children. Meta-analytic methods were applied to aggregate available data.
A total of 16 studies met inclusion criteria. Across 14 studies (n = 1330 children), MDI scores were strongly predictive for later cognitive functioning, r = 0.61 (95%CI: 0.57–0.64), explained variance 37%, p < .001. The relationship between MDI scores and later cognitive function was not mediated by birth weight (p = .56), gestational age (p = .70), and time interval between assessments (p = .55). Across five studies (n = 555 children), Bayley motor scale scores were moderately predictive for later motor function, r = 0.34 (95%CI: 0.26–0.42), explained variance 12%, p < .001.
In very preterm/VLBW children, MDI scores explain 37% of the variance in later cognitive functioning, whereas Bayley motor scale scores explain 12% of later motor function. Thus a large proportion of the variance remains unexplained, underlining the importance of enhancing prediction of developmental delay in very preterm children.
Neurosensory Disabilities at School Age in Geographic Cohorts of Extremely Low Birth Weight Children Born Between the 1970s and the 1990s
2009, Journal of Pediatrics
Citation Excerpt :
The 1979-1980 ELBW cohort comprised 89 consecutive survivors to age 8 years out of 351 live births, a survival rate of 25.4%. The outcome of this cohort at age 8 years was initially reported in 1991.12 The children were assessed using similar techniques as those used for the other cohorts, but with IQ assessed using the Wechsler Intelligence Scale for Children–Revised (WISC-R).13
To contrast the rates of neurosensory disabilities at age 8 years in extremely low birth weight (ELBW; birth weight 500 to 999 g) children born in the state of Victoria, Australia in 4 four distinct eras from the late 1970s to the late 1990s.
Study subjects were assessed at age 8 years. Results were compared among 4 ELBW cohorts (87 of 89 children born in 1979-1980, 206 of 212 born in 1985-1987, 224 of 241 born in 1991-1992, and 160 of 170 born in 1997), and between each of these ELBW cohorts and normal birth weight (NBW; birth weight > 2499 g) controls.
The survival rate for ELBW children rose from 25% for the 1979-1980 cohort to 73% for the 1997 cohort. No statistically significant differences in the disability rates were seen in the 4 eras; however, in the 1997 cohort, disability rates were significantly higher in the ELBW children compared with NBW controls: mild disability, 36.7% vs 9.8%; moderate disability, 10.1% vs 2.3%; and severe disability, 8.2% vs 0.6%.
The survival rate of ELBW children continues to rise over time. Despite this, however, the rates of disability in these vulnerable children at school age have remained stable and high relative to controls.
Developmental outcome of extremely low birth weight infants (< 1,000 g) during the first three years of life
2008, Anales de Pediatria
Debido a los avances en obstetricia y neonatología nos encontramos actualmente con un aumento importante de recién nacidos prematuros y una mayor supervivencia de éstos. Son niños con mayor riesgo de alteraciones en su desarrollo, por lo que es necesario un seguimiento y una actuación precoces, además de una prevención desde el período neonatal.
Se evalúan 116 prematuros de peso menor o igual a 1.000 g que ingresaron en nuestra unidad durante 5 años. Sobrevivieron al período neonatal 75 (64,7 %) y se hizo un seguimiento de su desarrollo durante los primeros 3 años de vida.
En esos 5 años aumentó el 100 % el número de ingresos de recién nacidos de bajo peso extremado y la supervivencia subió el 15 %. La secuela más frecuente fue el retraso ponderal; más de la mitad no seguían una curva normal en sus primeros 2 años de vida (el 58 % el primer año, el 57 % el segundo año y el 40 % el tercer año) aunque tendían progresivamente a la normalidad, salvo aquéllos nacidos con retraso del crecimiento intrauterino, que tuvieron peor pronóstico. En cuanto al desarrollo neurológico, las secuelas motoras fueron las más graves; lo más frecuente fueron mínimas alteraciones en la motricidad que no comprometían la vida normal del niño, pero el 14% presentaba signos de parálisis cerebral el primer año de vida, el 17,4 % el segundo año y el 19 % el tercer año. Aunque el porcentaje de retinopatía de la prematuridad en nuestro grupo fue alto (74 %), las secuelas oftalmológicas fueron escasas (el 3,2 % el primer año, el 3,9 el Segundo año y el 2,4 % el tercer año), así como las auditivas (sordera, 2,0 %). El desarrollo del lenguaje y el psicomotor fue normal en la mayoría de los niños y los que presentaron algún retraso fue leve o moderado.
Nos encontramos ante un aumento importante de la incidencia y supervivencia de recién nacidos de bajo peso extremo, con mayor riesgo de presentar secuelas en su desarrollo. La más frecuente es el retraso en la curva ponderal y la más grave, la parálisis cerebral; las alteraciones oftalmológicas y auditivas graves son poco frecuentes y el desarrollo psicomotor y del lenguaje es normal en la mayoría de estos niños.
Obstetrics and Perinatal Care has improved in the last few years. As a result there has been a significant increase in preterm babies and longer survival. The risk of abnormalities in their development is high; they need follow up, prompt action and prevention from the neonatal period.
We evaluated 116 preterm babies, birth weight less than or equal to 1,000 grams, admitted to our Unit over 5 years. Seventy five neonates survived after the neonatal period (64.7 %). We studied the development during the first three years of life.
The number of admissions of extremely low birth weigh infants has increased by 100 % in the last five years and the survival has increased by 15 %. Failure to thrive was the most frequent problem; in the first 2 years of life neonatal growth retardation was present in more than 50 % of cases (58 % 1st year, 57 % 2nd year, 40 % 3rd year). Catch-up growth occurred except in infants who had intrauterine growth retardation. Motor function disorders were the most serious; minor alterations in this system were the most frequent but usually did not compromise the life of the patient. Cerebral palsy was present in 14% in the 1^st year of life, 17,4 % 2^nd year and 19 % 3^rd year. Retinopathy of prematurity was very high in our group (74 %), but ophthalmic sequela were infrequent (3.2 % 1^st year, 3.9 % 2^nd year, and 3.4 % 3^rd year); similarly with hearing function (deafness 2.0 %). Only some mild or moderate language development delay was present and psychomotor development was normal in the majority of cases and those who were retarded improved with time.
Nowadays there is a significant increase in the incidence and survival of extremely low birth weigh infants. They have a higher risk of abnormal development. The most frequent problem is failure to thrive and the most serious is cerebral palsy. Major ophthalmic and hearing sequela are rare. Psychomotor and language development is normal in the majority of these patients.
Risk Assessment and Neurodevelopmental Outcomes
2005, Avery's Diseases of the Newborn
Regionalized long-term follow-up
2004, Seminars in Neonatology
The importance of population-based long-term follow-up studies of geographically determined cohorts to evaluate the effectiveness, efficiency and availability of a regionalized perinatal–neonatal care programme is demonstrated by the Victorian Infant Collaborative Study Group. The survival and quality of survival of consecutively born extremely-low-birthweight infants below 1000 g or extremely preterm infants below 28 weeks' gestation in the state of Victoria were assessed up to 14 years of age over four distinctive eras: 1979–1989, 1985–1987, 1991–1992 and 1997. Both survival and quality-adjusted survival rates rose progressively in all birth weight and gestation subgroups, associated with progressively more such infants being born in level III perinatal centres. Cost–effectiveness and cost–utility ratios remained stable overall, with efficiency gains in the smaller infants over time. Regionalized long-term follow-up provides unique information that is not available from institution-based studies, which is vital to the regional organization of perinatal–neonatal care.

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^†: Supported by the Health Department, Victoria, Royal Women's Hospital—3AW Clinical Research Foundation and Monash Medical Research Fund.

^*: Study group members: W. Kitchen, MD (convener), N. Campbell, MD, E. Carse, MD, M. Charlton, MEdPsych, L. Doyle, MD, J. Drew, MD, G. Ford, MD, J. Gore, RN, E. Kelly, MA, P. McDougall, MD, A. Rickards, MA, A. Watkins, MD, and V. Yu, MD.

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Eight-year outcome in infants with birth weight of 500 to 999 grams: Continuing regional study of 1979 and 1980 births†

J Pediatr

J Pediatr

Am J Obstet Gynecol

J Pediatr

Manual for the Wechsler Intelligence Scale for Children—Revised

Manual for the Neale Analysis of Reading Ability

Bayley Scales of Infant Development

Manual for the Wechsler Preschool and Primary Scales of Intelligence

SPSS-X: users guide

Measures of response agreement for qualitative data: some generalizations and alternatives

Psychol Bull