Impairments, disabilities, and handicaps of very preterm and very-low-birthweight infants at five years of age

doi:10.1016/0140-6736(91)90015-H

The Lancet

Volume 338, Issue 8758, 6 July 1991, Pages 33-36

https://doi.org/10.1016/0140-6736(91)90015-H Get rights and content

Abstract

The Project On Preterm and Small for gestational age infants (POPS) was started in the Netherlands in 1983 to investigate the relation between prenatal/ perinatal factors and mortality/morbidity in very preterm and very-low-birthweight infants. Of the 1338 liveborn infants (< 32 weeks and/or < 1500 g) 966 were enrolled in the five-year (chronological age) follow-up programme; 96% of these children were assessed during a home visit. The overall outcome was expressed as impairments, disabilities, and handicaps according to World Health Organisation criteria. Of the assessed children, 13% had a disability and 14% were handicapped, which are much higher frequencies than those found in the general population. Handicaps were due mainly to abnormalities of neuromotor function, mental development, or language and speech development. Compared with the handicap frequency in the same cohort at two years of age, a more favourable outcome at five years of age was seen in 10%, and a less favourable outcome in 7% of the children. The findings show that most of those high-risk children survived without handicap or serious disability at preschool age.

References (37)

Sp Verloove-Vanhorick et al.
Neonatal mortality risk in relation to gestational age and birthweight. Results of a national survey of preterm and very-low-birthweight infants in the Netherlands
Lancet
(1986)
H. Wierenga et al.
Prenatal risk factors for cot death in very preterm and small for gestational age infants
Early Hum Dev
(1990)
S. Saigal et al.
Follow-up of infants 501 to 1,500 gm birthweight delivered to residents of a geographically defined region with perinatal intensive care facilities
J Pediatr
(1982)
Tg Powell et al.
Survival and morbidity in a geographically defined population of low birthweight infants
Lancet
(1986)
Gp Aylward et al.
Outcome studies of low birthweight infants published in the last decade: A metaanalysis
J Pediatr
(1989)
Wh Kitchen et al.
Children of birthweight < 1000 g: changing outcome between ages 2 and 5 years
J Pediatr
(1987)
H. Bauchner et al.
Premature graduates of the newborn intensive care unit: a guide to follow-up
Pediatr Clin N Am
(1988)
M. van de Bor et al.
Incidence and prediction of periventricular-intraventricular hemorrhage in very preterm infants
J Perinat Med
(1987)
N. Beganovic et al.
Total parenteral nutrition and sepsis
Arch Dis Child
(1988)
M. van de Bor et al.
Patent ductus arteriosus in a cohort of 1338 perterm infants: a collaborative study
Paediatr Perinat Epidemiol
(1988)

Laa Kollée et al.

Maternal and neonatal transport: results of a national collaborative survey of preterm and very low birthweight infants in the Netherlands

Obstet Gynecol

(1988)

Sp Verloove-Vanhorick et al.

Mortality in very preterm and very low birthweight infants according to place of birth and level of care: results of a national collaborative survey of preterm and very low birthweight infants in the Netherlands

Pediatrics

(1988)

Fj Walther et al.

A prospective survey of necrotising enterocolitis in very low birthweight infants

Pediatr Perinat Epidemiol

(1989)

M. van de Bor et al.

Outcome of periventricular-intraventricular hemorrhage at 2 years of age in 484 very preterm infants admitted to 6 neonatal intensive care units in the Netherlands

Neuropediatrics

(1988)

M. van de Bor et al.

Hyperbilirubinemia in preterm infants and neurodevelopmental outcome at 2 years of age: results of a national collaborative survey

Pediatrics

(1989)

Sp Verloove-Vanhorick et al.

The male disadvantage in very low birthweight infants: does it really exist?

Eur J Pediatr

(1989)

Tm Zeben van-van der Aa et al.

Morbidity of very low birthweight infants at corrected age of two years in a geographically defined population

Lancet

(1989)

Dmcb Zeben van-van der Aa

Outcome at two years of age in very preterm and very low birthweight infants in the Netherlands. Thesis

(1989)

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Citation Excerpt :
Most of the children with an abnormal outcome had a combination of neuromotor, mental or other handicaps or disabilities. The most common disabilities were neuromotor abnormalities (30%, after exclusion of major congenital anomalies), abnormalities in visual functioning (27.7%, including 19.3% strabismus), and hearing loss (13.8% unspecified and 1.5% sensorineural) [10–12,26]. At the age of 10–11 years, 44% of the children had any disability (walking, hand function, vision, hearing, speech, or cognition); 19% had one mild disability, 16% had more than one mild disability and 10% had one or more severe disabilities.
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Le taux de naissances avant 33 semaines d’aménorrhée (SA) avait significativement augmenté, multiplié par 3 en 12 ans pour atteindre 1,7 % des naissances en 2006. Aucune augmentation de la prématurité induite n’était observée ; cependant, en cas de prématurité induite les césariennes avant travail avaient significativement augmenté. Concernant l’évolution des étiologies, les infections urinaires et vaginales diminuaient le plus significativement, suivies des malformations fœtales. Seules les grossesses multiples augmentaient significativement. La principale cause de naissances avant 33SA était l’hypertension. Avant 28SA, les naissances dues à des infections et métrorragies étaient significativement plus importantes par rapport aux 28–32SA.
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Évaluer depuis 12 ans l’évolution de la fréquence des naissances avant 33 semaines d’aménorrhée et la place de la prématurité induite parmi celles-ci. Déterminer l’évolution des différentes étiologies des naissances avant ce terme.
Étude rétrospective, de 1994 à 2006, portant sur les mères ayant accouché entre 22 et 32 + six jours sur les maternités du réseau de l’Association des utilisateurs de dossiers informatisés en pédiatrie, obstétrique et gynécologie (AUDIPOG). Trois mille sept cent quatre-vingt-un accouchements ont été inclus. Un lien statistique a été recherché entre la catégorie de terme (grande/extrême prématurité) et le type de prématurité (induite/spontanée) ou le mode d’accouchement en cas de prématurité induite (césarienne avant travail/déclenchement). L’évolution des différentes étiologies a été étudiée de 2000 à 2006.
Le taux de naissances avant 33 semaines d’aménorrhée (SA) avait significativement augmenté, multiplié par 3 en 12 ans pour atteindre 1,7 % des naissances en 2006. Aucune augmentation de la prématurité induite n’était observée ; cependant, en cas de prématurité induite les césariennes avant travail avaient significativement augmenté. Concernant l’évolution des étiologies, les infections urinaires et vaginales diminuaient le plus significativement, suivies des malformations fœtales. Seules les grossesses multiples augmentaient significativement. La principale cause de naissances avant 33SA était l’hypertension. Avant 28SA, les naissances dues à des infections et métrorragies étaient significativement plus importantes par rapport aux 28–32SA.
Les naissances avant 33SA sont un phénomène important qui doit être surveillé car leur part augmente régulièrement en France.
Evaluate the incidence of births before 33 weeks of amenorrhea over a 12-year period and the place of prematurity induced among them. Determine the evolution of various causes of birth prior to that and draw up a detailed inventory.
This is a retrospective study from 1994 to 2006, concerning mothers who gave birth in the Network Users Association of computerized records in Pediatrics, Obstetrics and Gynecology (AUDIPOG) between 22 and 32 + 6 days of maternity. A total of 3781 deliveries were included. The statistical significance of links between the degree of prematurity (high prematurity/extreme prematurity) and the type of prematurity (induced/spontaneous) or mode of early work in the event of induced prematurity (trigger/prior cesarean work) was determined. The evolution of different etiologies was also studied with a complete inventory in 2006.
We observed a significant increase in the rate of births before 33SA: it was multiplied by 3 in 12 years and stood at 1.7% of births in 2006. No increase in prematurity induced was observed, but in case of preterm labor induced the number of births by caesarean section increased significantly. Concerning the evolution of etiologies, vaginal and urinary infections decreased the most, followed by fetal malformations. Only multiple pregnancies increased significantly. The principle cause of preterm birth was hypertension. Prior to 28SA, premature births were caused by metrorrhagia and infections at greater levels than 28–32SA.
The growing number of births before 33SA is a serious phenomenon that must be monitored as they are increasingly common in France.

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CHILD HEALTHImpairments, disabilities, and handicaps of very preterm and very-low-birthweight infants at five years of age

Abstract

Lancet

Early Hum Dev

J Pediatr

Lancet

J Pediatr

J Pediatr

Pediatr Clin N Am

Incidence and prediction of periventricular-intraventricular hemorrhage in very preterm infants

J Perinat Med

Total parenteral nutrition and sepsis

Arch Dis Child

Patent ductus arteriosus in a cohort of 1338 perterm infants: a collaborative study

Paediatr Perinat Epidemiol

Maternal and neonatal transport: results of a national collaborative survey of preterm and very low birthweight infants in the Netherlands

Obstet Gynecol

Mortality in very preterm and very low birthweight infants according to place of birth and level of care: results of a national collaborative survey of preterm and very low birthweight infants in the Netherlands

Pediatrics

A prospective survey of necrotising enterocolitis in very low birthweight infants

Pediatr Perinat Epidemiol

Outcome of periventricular-intraventricular hemorrhage at 2 years of age in 484 very preterm infants admitted to 6 neonatal intensive care units in the Netherlands

Neuropediatrics

Hyperbilirubinemia in preterm infants and neurodevelopmental outcome at 2 years of age: results of a national collaborative survey

Pediatrics

The male disadvantage in very low birthweight infants: does it really exist?

Eur J Pediatr

Morbidity of very low birthweight infants at corrected age of two years in a geographically defined population

Lancet

Outcome at two years of age in very preterm and very low birthweight infants in the Netherlands. Thesis

CHILD HEALTH
Impairments, disabilities, and handicaps of very preterm and very-low-birthweight infants at five years of age