Two-year outcome of infants weighing 600 grams or less at birth and born 1994 through 1998

doi:10.1016/S0029-7844(02)02451-1

Obstetrics & Gynecology

Volume 101, Issue 1, January 2003, Pages 18-23

https://doi.org/10.1016/S0029-7844(02)02451-1 Get rights and content

Abstract

Objective

To assess the neurologic and developmental outcome at 2 years of age in preterm infants with birth weights 600 g or lower.

Methods

We conducted a retrospective review from January 1994 through December 1998 for placental histopathology, maternal factors, neonatal intensive care unit course, growth, neurologic/special sense status, and development at 2 years of age corrected for prematurity.

Results

Of the 104 neonates weighing 600 g or less, 24 survived to nursery discharge (23%). Two infants died of chronic lung disease after discharge, and 21 of the remaining 22 infants (95%) returned for follow-up. Placental pathology was available for 21 (95%); acute inflammation was present in 67%, and other abnormalities occurred in 76%. Mean birth weight was 537 (430–600) g, and mean gestational age was 24 (22–27) weeks. At birth, 55% were below the tenth percentile for birth weight. At nursery discharge and 2 years of age, 94% were below the tenth percentile for weight, length, and head circumference. Nineteen of 21 (90%) infants were abnormal on neurodevelopmental follow-up. Major problems were cerebral palsy, blindness, gastrostomies, and ventriculoperitoneal shunts.

Conclusion

Abnormal placental histology was present in all but one infant, suggesting fetal injury before birth. Only eight of 20 infants with chorioamnionitis were diagnosed clinically, and all infants had a complicated course. We found a high incidence of intrauterine growth restriction and an almost universal pattern of impaired postnatal growth with extremely poor neurodevelopmental outcome at 2 years of age.

Section snippets

Materials and methods

We reviewed the neonatal intensive care unit (NICU) discharge summaries, placental pathology reports, and follow-up clinic records for all surviving neonates born weighing 600 g or less from January 1, 1994, through December 31, 1998, at the Women’s and Children’s Hospital. The hospital is part of the Los Angeles County + University of Southern California Medical Center, a large public hospital for indigent patients primarily of Mexican and Central American origin. Approval for this study was

Results

During the 5-year period beginning in January 1994 through December 1998, 104 infants weighing 600 g or less were born at our hospital. Twenty-four of these infants survived to discharge (23%), and two of the 24 survivors died within 2 weeks of discharge because of chronic lung disease. Of the remaining 22 infants, 21 (95%) returned for follow-up clinic visits. Only 1 year of follow-up was available for one of the 21 infants. The remaining 20 infants were seen in our follow-up clinic at 2 years

Discussion

The survival rate for our cohort at 23% compared favorably to that reported nationally, at 23%; however, we documented higher rates of long-term morbidity than previously reported. A recent study of all infants born 25 weeks or less in the United Kingdom and Ireland reported a survival of 20% and disability at 30 months of 72%.10 To better understand our outcomes, we suggest five potential explanations. First, we believe that the outcomes of our infants were greatly influenced by abnormal fetal

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Is chorioamnionitis associated with hearing impairment in preterm infants? A systematic review and meta-analysis
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It has been reported that chorioamnionitis (CA) could increase the risk of hearing impairment in premature infants, but results are inconsistent. A meta-analysis was performed to systematically evaluate the relationship between CA and hearing impairment in premature infants.
Search in PubMed, Embase, Cochrane Library from their inception to May 2020. We concluded all cohort and case-control studies which explored the associations between CA and hearing impairment in preterm infants. Pregnant women with other infections besides CA were excluded. PRISMA guidelines were followed. Fixed-and random-effects models were used, depending on heterogeneity. And we performed to calculate odds ratio (ORs), and 95% CIs using fixed-effects models.
Seven studies involving 4134 premature infants were included. There was non-significant association between CA and hearing impairment (adjusted OR 1.43, 95% CI 0.99 to 2.04, P = 0.05; heterogeneity: I² = 13%, P = 0.33).
This article concludes that CA is not a risk factor for hearing impairment in premature infants, but most of the current studies are retrospective studies with low intensity and lack of high-quality articles to discuss it.
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Citation Excerpt :
Failure to thrive during the first year of life has shown severe long-term problems and implications, as nutrition and growth can have an impact on the motor, cognitive, and psychological development of these children. Feeding difficulties predispose children to recurrent respiratory infections, gastrointestinal disorders, and behavioral and language problems.5,22,33,36–43 Another group of factors that can influence the performance of preterm infants’ feeding are medical complications associated with prematurity.
To analyze the scientific literature on dietary changes in preterm children during the first years of life.
The PubMed database was used for article selection. The texts were analyzed according to their objectives, research design, and research group characteristics. The following were selected to comprise the criteria: (1) publications in the period from 1996 to 2014; (2) participation of infants and children from birth to 10 years of age; (3) development of oral motor skills necessary for feeding; (4) development of the feeding process; and (5) feeding difficulties during childhood.
There were 282 studies identified, of which 17 were used in the review, and five more articles were identified through the reference list of selected articles, totaling 22 references.
Very low birth weight preterm newborns are more likely to have feeding problems in early postnatal stages and during childhood when compared with full-term infants. Monitoring the feeding of these infants after hospital discharge is strictly recommended in an early intervention program aiming at better development of feeding skills.
Analisar a literatura científica sobre alterações alimentares em crianças prematuras durante os primeiros anos de vida.
A base de dados do Pubmed foi a percursora para a seleção dos artigos. Os textos foram analisados quanto aos seus objetivos; desenhos da pesquisa; características do grupo pesquisa e foram selecionados os seguintes temas para compor os critérios: (1) publicações no período de 1996 a 2014; (2) participação de bebês e crianças, do nascimento até os 10 anos de idade; (3) desenvolvimento das habilidades motoras orais necessárias para a alimentação; (4) desenvolvimento do processo de alimentação e (5) dificuldades alimentares durante a infância.
foram identificados 282 estudos, destes 17 foram utilizados e 5 artigos foram identificados por meio da lista de referência bibliográfica dos artigos selecionados, totalizando 22 referências bibliográficas.
A revisão permitiu concluir que recém-nascidos pré-termo muito baixo peso (RNPTMBP) são mais propensos a apresentarem problemas de alimentação nos estágios iniciais pós-natal e durante a infância quando comparados com crianças a termo. O monitoramento da alimentação após a alta hospitalar é estritamente recomendado em um programa de intervenção precoce com vistas ao melhor desenvolvimento das habilidades alimentares.
Neurodevelopmental outcomes of premature infants at a tertiary care center in Pakistan
2012, Pediatric Neurology
The low gestational ages and morbidities of premature neonates in neonatal intensive care units exert a significant impact on neurodevelopmental outcomes. This longitudinal cohort study assessed the neurodevelopmental status of premature neonates after discharge from neonatal intensive care units in resource-limited countries such as Pakistan. Developmental assessment involved the Denver Development Screening Test II. One hundred and ten infants discharged from our neonatal intensive care unit completed follow-up at age 6 months. Overall developmental delay was evident in 32% of infants. Birth weight and gestational age exerted significant impacts on development. The mean gestational age of developmentally normal infants was 34 weeks, whereas that of delayed infants was 30.7 weeks (P < 0.01). The mean birth weight of developmentally normal infants was 2.17 kg vs 1.27 kg in delayed infants (P < 0.01). Neonates who developed complications such as respiratory distress syndrome, intraventricular hemorrhage, thrombocytopenia, hypoglycemia, hyponatremia, or hypothermia in neonatal intensive care units proved to be delayed at age 6 months (P < 0.05). Prematurity and its associated complications are linked to adverse neurodevelopmental outcomes.
Hearing Loss, Auditory Neuropathy, and Neurological Co-morbidity in Children with Birthweight <750 g
2012, Archives of Medical Research
The current literature considers a birthweight <1,500 g as a risk factor for sensorineural hearing loss (SNHL, hearing threshold >25 decibels), auditory neuropathy (AN), and several neurological sequelae. The aim of the study was to determine the frequency and risk factors associated with SNHL, AN, and neurological morbidity in a group of children with birthweights of <750 g treated at a neonatal care unit and recruited into a long-term follow-up program.
A case-control study was carried out. Inclusion criteria were birthweight <750 g and born between the years 2000 and 2010. We performed brainstem auditory-evoked potentials (BAEP), evoked otoacoustic emissions (EOAE) and free-field audiometry (FFA) in this population. Neonatal variables and procedures were compared between children with SNHL and children with normal bilateral hearing (NBH).
A total of 93 children with a mean age of 4 years were included in the follow-up. Six children (6.4%) had SNHL and 87 had NBH. We were unable to identify AN in the sample. Mean weight for this sample was 673 ± 68 g and gestational age 27.5 ± 2 weeks. Variables reflecting differences between groups included days under mechanical ventilation, furosemide treatment, and bronchopulmonary dysplasia. In the SNHL group, three patients had periventricular leukomalacia, two had hydrocephalus, and one patient had cerebral palsy.
Frequency of SNHL in children with birthweights <750 g was higher than in other premature infants and was related with mechanical ventilation, furosemide application, and bronchopulmonary dysplasia. Association with other neurological morbidities was frequent. Early diagnosis and intervention are required.
Eating as a Neurodevelopmental Process for High-Risk Newborns
2011, Clinics in Perinatology
Impact of histological chorioamnionitis, funisitis and clinical chorioamnionitis on neurodevelopmental outcome of preterm infants
2011, Early Human Development
Citation Excerpt :
Chorioamnionitis is a frequent cause of preterm birth [1,4–7]. Preterm infants born to mothers with chorioamnionitis are at risk for adverse neurodevelopmental outcome [5,8–18]. Several authors have observed an increased risk of severe intraventricular hemorrhage (IVH) [19–24] and/or periventricular leukomalacia (PVL) [20,21,25] in preterm infants exposed to chorioamnionitis.
The role of chorioamnionitis in neurodevelopment of preterm infants is not fully understood.
To examine the association between different indicators of intrauterine inflammation (clinical chorioamnionitis, histological chorioamnionitis and funisitis) and neurodevelopmental impairment in very preterm infants.
Preterm infants with a birth weight of < 1500 g or a gestational age of < 32 weeks were included. Follow-up evaluation up to 2 years of age consisted of neurological examination, neurodevelopmental assessment and visual and audiologic tests. Outcome data were compared between the chorioamnionitis and the control groups, controlling for gestational age, birth weight and Apgar score at 5 min.
One hundred seventy-seven patients comprised the study population (mean gestational age 29 ± 2 weeks, mean birth weight 1167 ± 344 g). Histological chorioamnionitis was present in 49% of placentas, whereas funisitis was observed in 25%. In 57% cases clinical maternal chorioamnionitis was suspected. Follow-up was available for 130 (82%) patients. Infants with funisitis, compared with controls, had a significantly higher incidence of moderate to severe disability (18% vs 5%, OR 4.07; 95% CI 1.10–15.09).
The results of this study suggest that, unlike a broad definition of histological chorioamnionitis including inflammation of maternal or fetal placental tissues, funisitis may entail a higher risk of moderate to severe disability at 2 years of age in preterm infants.

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Original researchTwo-year outcome of infants weighing 600 grams or less at birth and born 1994 through 1998

Abstract

Objective

Methods

Results

Conclusion

Section snippets

Materials and methods

Results

Discussion

Obstet Gynecol

J Pediatr

Clin Perinatol

Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Improving outcome into the 1990s for infants weighing 500–999 grams at birth

Arch Dis Child

Outcome among surviving very low birthweight infantsA meta-analysis

Arch Dis Child

Before viabilityA geographically based outcome study of infants weighing 500 grams or less at birth

Pediatrics

Neurodevelopment and predictors of outcomes of <1000 gram birth weight children born 1992–1995

Arch Pediatr Adolesc Med

Clinical, scientific and ethical aspects of fetal and neonatal care at extremely preterm periods of gestation

Br J Obstet Gynaecol

Original research
Two-year outcome of infants weighing 600 grams or less at birth and born 1994 through 1998