Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

A Population-based Study of Prognostic Factors Related to Major Disability in Very Preterm Survivors

Abstract

OBJECTIVE: This study was conducted to determine the rates and risk factors for major disability in very preterm survivors born to residents of Nova Scotia, Canada between 1992 and 1996.

STUDY DESIGN: A cohort study was conducted of all 355 infants born to Nova Scotia residents between 22 and 30 weeks gestation. Major disability was defined by mental development index <70, moderate or severe cerebral palsy, bilateral visual acuity <20/200, or deafness requiring bilateral hearing aids. Logistic regression analysis was used to determine which factors were significantly associated with major disability.

RESULTS: Of the infants who survived 1 year and had follow-up data, 21 (8.3%) developed a major disability. Cystic periventricular leukomalacia (PVL), hypernatremia and surgery requiring general anesthesia were independently associated with the development of a major disability.

CONCLUSION: This study confirms the association between cystic PVL and major disability observed in other studies. Surgery and hypernatremia will be important to verify in future studies since preventive measures may be possible.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  • Bregman J . Developmental outcome in very low birthweight infants — current status and future trends. Pediatr Clin North Am 1998;45:673–690.

    Article  CAS  Google Scholar 

  • Lorenz JM, Wooliever DE, Jetton JR, Paneth N . A quantitative review of mortality and developmental disability in extremely premature newborns. Arch Pediatr Adolesc Med 1998;152:425–435.

    Article  CAS  Google Scholar 

  • Vohr BR, Wright LL, Dusick AM, et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993–1994. Pediatrics 2000;105:1216–1226.

    Article  CAS  Google Scholar 

  • O'Shea TM, Klinepeter KL, Goldstein DJ, Jackson BW, Dillard RG . Survival and developmental disability in infants with birth weights of 501–800 g born between 1979 and 1994. Pediatrics 1997;100:982–986.

    Article  CAS  Google Scholar 

  • El-Metwally D, Vohr B, Tucker R . Survival and neonatal morbidity at the limits of viability in the mid 1990s: 22 to 25 weeks. J Pediatr 2000;137:616–622.

    Article  CAS  Google Scholar 

  • Roth J, Resnick MB, Ariet M, et al. Changes in survival patterns of very low birth weight infants from 1980 to 1993. Arch Pediatr Adolesc Med 1995;149:1311–1317.

    Article  CAS  Google Scholar 

  • Tin W, Wariyar U, Hey E . Changing prognosis for babies of less than 28 weeks gestation in the north of England between 1983 and 1994. BMJ 1997;314:107–111.

    Article  CAS  Google Scholar 

  • Tudehope D, Burns YR, Gray PH, Mohay HA, O'Callaghan MJ, Rodgers YM . Changing patterns of survival and outcome at 4 years of children who weighed 500–999 g at birth. J Paediatr Child Health 1995;31:451–456.

    Article  CAS  Google Scholar 

  • The Victoria Infant Collaborative Study Group . Improved outcome into the 1990s for infants weighing 500–999 g at birth. Arch Dis Child Fetal Neonatal Ed 1997;77:F91–F94.

    Article  Google Scholar 

  • Hack M, Friedman H, Fanaroff AA . Outcomes of extremely low birth weight infants. Pediatrics 1996;98:931–937.

    CAS  PubMed  Google Scholar 

  • Bhushan V, Paneth N, Kiely JL . Impact of improved survival of very low birth weight infants on recent secular trends in the prevalence of cerebral palsy. Pediatrics 1993;91:1094–1100.

    CAS  PubMed  Google Scholar 

  • Lefebvre F, Glorieux J, St Laurent Gagnon T . Neonatal survival and disability rate at age 18 months for infants born between 23 and 28 weeks of gestation. Am J Obstet Gynecol 1996;174:833–838.

    Article  CAS  Google Scholar 

  • Robertson C, Sauve RS, Christianson HE . Province based study of neurologic disability among survivors weighing 500 through 1249 g at birth. Pediatrics 1994;93(4):636–640.

    CAS  PubMed  Google Scholar 

  • Wood NS, Marlow N, Costeloe K, Gibson AT, Wilinson AR . Neurologic and developmental disability after extremely preterm birth. N Engl J Med 2000;343:378–384.

    Article  CAS  Google Scholar 

  • Spinillo A, Capuzzo E, Piazzi G, Baltaro F, Stronati M, Ometto A . Significance of low birthweight for gestational age among very preterm infants. Br J Obstet Gynaecol 1997;104:668–673.

    Article  CAS  Google Scholar 

  • Arnold CC, Kramer MS, Hobbs CA, McLean FH, Usher RH . Very low birth weight: A problematic cohort for epidemiologic studies of very small or very immature neonates. Am J Epidemiol 1991;134:604–613.

    Article  CAS  Google Scholar 

  • Msall ME, Buck GM, Rogers BT, et al. Multivariate risks among extremely immature infants. J Perinatol 1994;14:41–47.

    CAS  PubMed  Google Scholar 

  • Sauve RS, Guyn L, Young . The 500–750 g infant: Who beats the odds?. Pediatr Res 1991;29:1567.

    Google Scholar 

  • Yeo CL, Choo S, Ho LY . Chronic lung disease in very low birth weight infants: A 5 year review. J Paediatr Child Health 1997;33:102–106.

    Article  CAS  Google Scholar 

  • Piecuch RE, Leonard CH, Cooper BA, Sehring SA . Outcome of extremely low birth weight infants (500–999 g) over a 12 year period. Pediatrics 1997;100:633–639.

    Article  CAS  Google Scholar 

  • Aziz K, Vickar DB, Sauve RS, Etches PC, Pain KS, Robertson CM . Province based study of neurologic disability of children weighing 500 through 1249 g at birth in relation to neonatal cerebral ultrasound findings. Pediatrics 1995;95:837–844.

    CAS  PubMed  Google Scholar 

  • Verloove-Vanhorick SP, Veen S, Ens Dokkum MH, Schreuder AM, Brand R, Ruys JH . Sex difference in disability and handicap at five years of age in children born at very short gestation. Pediatrics 1994;93:576–579.

    CAS  PubMed  Google Scholar 

  • Emsley HC, Wardle SP, Sims DG, Chiswick ML, D'Souza SW . Increased survival and deteriorating developmental outcome in 23–25 week gestation infants, 1990–4 compared with 1984–9. Arch Dis Child Fetal Neonatal Ed 1998;78:F99–F101.

    Article  CAS  Google Scholar 

  • Fowlie PW, Tarnow-Mordi WO, Gould CR, Strang D . Predicting outcome in very low birth weight infants using an objective measure of illness severity and cranial ultrasound scanning. Arch Dis Child Fetal Neonatal Ed 1998;78:F175–F178.

    Article  CAS  Google Scholar 

  • Murphy DJ, Sellers S, MacKenzie IZ, Yudkin PL, Johnson AM . Case–control study of antenatal and intrapartum risk factors for cerebral palsy in very preterm singleton babies. Lancet 1995;346:1449–1454.

    Article  CAS  Google Scholar 

  • Grether JK, Nelson KB . Maternal infection and cerebral palsy in infants of normal birth weight. JAMA 1997;278:207–211.

    Article  CAS  Google Scholar 

  • Yoon BH, Romero R, Park JS, et al. Fetal exposure to an intra-amniotic inflammation and the development of cerebral palsy at the age of three years. Am J Obstet Gynecol 2000;182:675–681.

    Article  CAS  Google Scholar 

  • Vermeulen GM, Bruinse HW, deVries LS . Perinatal risk factors for adverse neurodevelopmental outcome after spontaneous birth. Eur J Obstet Gynecol Reprod Biol 2001;99:207–212.

    Article  CAS  Google Scholar 

  • Cartlidge PH, Stewart JH . Survival of very low birth weight and very preterm infants in a geographically defined population. Acta Paediatr 1997;86:105–110.

    Article  CAS  Google Scholar 

  • Synnes AR, Ling EW, Whitfield MF, et al. Perinatal outcomes of a large cohort of extremely low gestational age infants (twenty-three to twenty — eight weeks completed gestation). J Pediatr 1994;125:952–960.

    Article  CAS  Google Scholar 

  • Johnson A, Townshend P, Yudkin P, Bull D, Wilkinson AR . Functional abilities at age 4 years of children born before 29 weeks gestation. BMJ 1993;306:1715–1718.

    Article  CAS  Google Scholar 

  • Simmons MA, Adcock EW, Bard H, Battaglia FC . Hypernatremia and intracranial hemorrhage in neonates. N Engl J Med 1974;291:6–10.

    Article  CAS  Google Scholar 

  • Sugimoto T, Yasuhara A, Matsumura T . Intracranial hemorrhage following administration of sodium bicarbonate in rabbits. Brain Dev 1981;3: 297–303.

    Article  CAS  Google Scholar 

  • Yasuhara A, Sugimoto T, Naito H, Yasuhara M, Matsumura T . Effects of hyperosmolality on the central nervous system and intracranial hemorrhage. Brain Dev 1982;4:353–360.

    Article  CAS  Google Scholar 

  • Haycock GB, Aperia A . Salt and the newborn kidney. Pediatr Nephrol 1991;5:65–70.

    Article  CAS  Google Scholar 

  • Trachtman H . Cell volume regulation: A review of cerebral adaptive mechanisms and implications for clinical treatment of osmolal disturbances: II. Pediatr Nephrol 1992;6:104–112.

    Article  CAS  Google Scholar 

  • Soupart A, Decaux G . Therapeutic recommendations for management of severe hyponatraemia: Current concepts on pathogenesis and prevention of neurologic complications. Clin Nephrol 1996;46:149–169.

    CAS  PubMed  Google Scholar 

  • Soupart A, Penninckx R, Namias B, Stenuit A, Perier O, Decaux G . Brain myelinolysis following hypernatremia in rats. J Neuropathol Exp Neurol 1996;55:106–113.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The contribution of the Perinatal Follow-up Program of Nova Scotia is gratefully acknowledged. Dr. Dodds is supported by a Research Investigatorship award from the IWK Health Centre and Clinical Research Scholar award from the Dalhousie University Faculty of Medicine.

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Perrott, S., Dodds, L. & Vincer, M. A Population-based Study of Prognostic Factors Related to Major Disability in Very Preterm Survivors. J Perinatol 23, 111–116 (2003). https://doi.org/10.1038/sj.jp.7210867

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7210867

Search

Quick links