Improving health status in extremely low birthweight children between two and five years

Health of VLBW infants in Germany at five years of age: What do parents describe?

BACKGROUND

There are only few data on medical problems and utilization of health services of former very low birth weight (VLBW) children at preschool age.

STUDY DESIGN

At five years of age parents of a cohort of VLBW children (N=862) received questionnaires, a medical interview and examination. The results were compared to the KIGGS cohort (Deutscher-Kinder-und Jugendgesundheitssurvey, N=777).

RESULTS

Parents of the VLBW and KIGGS cohort reported a very good or good health in 95% in their children. When compared to the KIGGS cohort, families in the VLBW cohort had a lower social economic status. The VLBW cohort suffered more frequently from disabilities (9.6% vs. 1.4%), from chronic bronchitis (45% vs. 17%) and from recurrent pain (headaches (20% vs. 7%), ear (16% vs. 6%), throat (23% vs. 8%), tooth (10% vs. 3%)). The VLBW cohort received more specialized care (ophthalmologist, ENT, orthopaedics, paediatric neurologist).

CONCLUSION

Families of VLBW children report a good health status in their children, but they utilized more specialized care. Higher rates of pain are reported in the VLBW cohort. Chronic bronchitis and various upper respiratory infections cause an increased morbidity in former VLBW children. Follow up programs are needed to develop optimal treatment and prevention strategies for these problems.

Ex-premature infant boys with hypospadias are similar in size to age-matched, ex-premature infant boys without hypospadias

OBJECTIVE

Studies have postulated that hypospadias, prematurity, and low birth weight are linked by defects in androgen signaling. To determine whether premature, hypospadiac boys are small and remain so, we compared their size at birth and at hypospadias repair to premature boys who underwent post-neonatal circumcision.

METHODS

We identified premature boys admitted to Texas Children's Hospital who underwent either hypospadias repair or circumcision after 4 months of age. Age, weight, and height at birth and surgery were recorded.

RESULTS

Fifty-four boys had hypospadias and 34 did not. For hypospadiac boys, the mean birth weight and age, height, and weight at surgery were lower than for boys without hypospadias. More importantly, length-for-age and weight-for-age percentiles were also lower for hypospadiac boys. When subset analysis was performed on boys younger than 2 years at surgery, however, there were no significant differences in height or weight between hypospadiac and non-hypospadiac boys.

CONCLUSION

Our series suggests that premature, hypospadiac boys are born smaller than age-matched, non-hypospadiac controls. However, there were no age-corrected size differences between hypospadiac and non-hypospadiac boys at surgery. This implies that hypospadiac boys exhibit post-neonatal 'rebound' growth. Global growth deficits, if any, do not persist in hypospadiac boys.

Outcome at 5 years of age of SGA and AGA infants born less than 28 weeks of gestation

The objective of this study was to compare the outcomes at 5 years of age of SGA and AGA children born < 28 weeks of gestation. The method used was a longitudinal follow-up of a cohort of 37 dyads of SGA and AGA infants matched by gestational age (GA), gender, and date of delivery. Mean GA was 26+/-1.2 weeks, and BW was 638+/-77 g for SGA and 833+/-134 g for AGA (P < 0.0001). The SGA infants remained lighter at 3, 24, and 60 months. Their head circumference was statistically smaller at 3 and 60 months, and their length remained lower but no longer statistically significant. There was no difference after the second year of life between SGA and AGA children in the need for rehospitalization (16% versus 11%) and the incidence of medical problems such as Otitis (38% versus 41%) and asthma (24% versus 30%). SGA exhibited more neurodevelopmental deficits (41% versus 30%) and severe handicaps, including CP, blindness, deafness, and mental retardation (22% versus 14%). Those deficits were seen predominantly in association with microcephaly, which was more prevalent in the SGA group. We conclude that the combination of severe prematurity and intrauterine growth retardation constitutes a serious developmental handicap and predisposes to physical and developmental delays. The presence of microcephaly further aggravates the prognosis.

Rehospitalization of extremely-low-birth-weight infants in first 2 years of life

AIMS

To determine whether (1) chronic lung disease (CLD) is the prime reason for extremely-low-birth-weight (ELBW) infant readmission during the first 2 years of life, (2) surfactant and other advanced therapies have reduced ELBW infant readmissions, (3) home oxygen therapy (HOT) is efficacious for this group.

STUDY DESIGN

The hospital records of these ELBW infants were reviewed retrospectively. Data on age, diagnosis, treatment, and duration of each hospitalization were compiled and analyzed for their association to CLD and to readmission for CLD and other reasons.

SUBJECTS

All 60 surviving infants with a birth body weight of less than 1001 g (ELBW) born from January 1993 to February 1998 were followed up to 2 years (mean 20.4 +/- 7.4 months) to evaluate their respiratory outcome.

RESULTS

Forty-two percent of these infants developed CLD. Upon discharge from the hospital, 28% (7/25) of the patients were given HOT for a median period of 60 days. Of the 47 ELBW infants who were studied the entire 2-year period, 72% were readmitted. Infants with CLD were readmitted more frequently (p=0.045) and had longer hospital stays during the first 2 years of life (p=0.034) than those without CLD. Respiratory illness was the main reason for readmission (55%) of these ELBW infants. The incidence of readmission due to respiratory tract infection was not significantly different in infants with CLD (61%) and infants without respiratory complications (44%) (p=0.159).

CONCLUSIONS

Infants with CLD (whether receiving HOT or not) showed no higher readmission rate due to respiratory infection, but the HOT group did have higher morbidity. The premature lung itself rather than the presence of CLD, as we would expect, makes ELBW infants more prone to readmission for respiratory illness.

Measurement of health status and quality of life in neonatal follow-up studies

Mortality and neuro-developmental outcome can be precisely measured but in order to interpret the significance of changes in them, further information is needed about health status, the effect of health status on lifestyle of survivors and their families, the quality of life experienced by survivors and the value placed by the public and survivors on different health states. The ability to measure such aspects of health now allows more relevant follow-up studies to be designed. This article discusses concepts of health status and quality of life and the problems in applying these to children. There follows a critique of modern instruments for measuring health status and quality of life and their application in neonatal follow-up studies. We recommend that only a small number of well-established instruments should be considered so that results are valid and can be compared with other studies.

Longitudinal study of neuropsychological outcome in blind extremely-low-birthweight children

This study evaluated neurological and psychological development in 10 blind children over a 4-year period. Five of the children were born preterm with an extremely low birthweight (ELBW) and a diagnosis of retinopathy, whereas the other five were term. All children received their first neurological examination at a mean age of 10 months and then annual follow ups. In addition, the Bielefeld Developmental Test for Blind Infants and Preschoolers (BDTB) was administered every 6 months (from the ages of 18 to 48 months) to assess developmental outcome in different domains (e.g. cognition, language, gross motor abilities). Results showed a higher number of peri- and neonatal complications in blind ELBW children as well as a significantly higher number of neurological symptoms over the 4-year period. At the mean age of 4 years 10 months, blind ELBW children had a significantly lower body weight, body height, head circumference, and body-mass index compared with the term children. Findings on psychological development revealed that blind ELBW children also had significantly lower scores on all domains covered by the BDTB. Finally, the overall score on the BDTB correlated significantly with gestational age, birthweight, duration of mechanical respiration, and days spent in hospital after delivery.

Extremely low birth weight and control infants at 2 years corrected age: a comparison of intellectual abilities, motor performance, growth and health

A 2-year cohort of 63 surviving extremely low birth weight (ELBW) infants was prospectively studied and 60 of these infants, together with 44 normal birth weight control infants, were assessed at 2 years of age for intellectual abilities, motor skills, growth and health. The total ELBW group differed significantly from controls on overall Griffiths developmental quotient (99.3 vs. 103.8 P = 0.02) and in the personal/social subscale (100.7 vs. 106.7 P = 0.01). A subset of 43 of the ELBW infants was identified as low risk at discharge. No statistically significant differences were present between the low risk ELBW subset and controls in intellectual abilities though both the total ELBW group and the low risk ELBW subset differed from controls in fine and gross motor abilities, and in weight at 2 years. The total ELBW group also experienced more frequent ill health and hospital readmission.

Perinatal outcomes of a large cohort of extremely low gestational age infants (twenty-three to twenty-eight completed weeks of gestation)

OBJECTIVES

To determine gestational age (GA)-specific mortality rates; the effects of GA, birth weight, sex, and multiple gestation on mortality rates; short-term morbidity for infants born at 23 to 28 weeks GA; and impairment rates at a corrected chronologic age of 18 months for those born at 23 to 25 weeks GA.

METHODS

A data base analysis was performed with a linked obstetric and a neonatal database. GA was determined by obstetric data and confirmed by early ultrasonography (available in 88%) on all births < 30 weeks GA at British Columbia's tertiary perinatal center from 1983 to 1989.

RESULTS

Of 1024 births occurring between 23 and 28 weeks GA, 911 were live born. The mortality rate decreased with increasing GA: 84% at 23 weeks; 57% at 24 weeks; 45% at 25 weeks; 37% at 26 weeks; 23% at 27 weeks; and 13% at 28 weeks GA. For each GA, mortality rate versus birth weight plots showed a decreasing mortality rate with increasing birth weight, except for infants who were large for GA. Male infants had a higher mortality rate than female infants (odds ratio, 1.8; confidence interval, 1.4 to 2.5). Twins fared worse than singletons with a decreasing effect from 24 weeks GA (odds ratio, 10.3) to no effect at 28 weeks GA. The median number of days supported by mechanical ventilation and the length of stay in the neonatal intensive care unit decreased markedly with increasing GA. Eighteen-month outcome of survivors between 23 and 25 weeks GA with 93% follow-up rate revealed an overall impairment rate of 36%, but 6 of the 9 surviving 23-week infants had major impairments.

CONCLUSIONS

The GA-specific perinatal outcome results of this large cohort provide information to assist in perinatal management decision making and for counseling parents prenatally.