[Children with birth weight 1500 g or under from Troms and Finnmark in the period 1978-1989]

During 1978-89, 245 women in Troms and Finnmark counties gave birth to 265 liveborn with birth weight < or = 1,500 g. The incidence of liveborn < or = 1,500 g, and of live- and stillborn < or = 1,500 g did not change significantly during the study period, but the stillborn proportion of live- and stillborn < or = 1,500 g decreased. The proportion of patients that had intrauterine transfer to hospitals with neonatal intensive care unit (72%), and neonatal transport (17%) did not change significantly. The mortality rate was constant (34%), probably due to change in registration practice leading to an increase in liveborn < or = 750 g. The handicap rate at four years of age decreased from 21% in 1978-81 to 12% in 1986-89, although the rates of moderate (8%) and severe (2%) handicap were unchanged. Cerebral palsy occurred in 10%, and blindness due to retinopathy of prematurity in 1%. The results are compatible with those of other studies from the same period.

Very low birthweight infants: outcome in a sub-Arctic population

OBJECTIVE

To evaluate the outcome for very low birthweight (VLBW) infants in northern Norway.

SUBJECTS AND METHODS

All live born infants (n = 536) with birthweight < or = 1500 g born during 1978-89 to women residing in the northern health region of Norway were studied retrospectively. Data were from the Medical Birth Registry (MBR), hospital records and from follow-up recordings to 4 y of age at maternal and child health centres. Stillborn infants (n = 269) with birthweight < or = 1500 g during the same period were also registered.

RESULTS

The annual incidence of live born VLBW infants (7.1/1000 live births) did not change, but the proportion of infants born alive before 26 weeks' gestation increased and the stillborn part decreased significantly. The Caesarean section (CS) rate, antenatal transfer and the use of a neonatal transport team increased significantly. Four hundred and seventy-five infants (89%) were considered viable at birth, 347 (65%) survived to 1 y and 343 (64%) to 4 y. The likelihood of survival was independently related to female gender. The trend for survival to 4 y of age did not increase significantly. Thirty children suffered from cerebral palsy (8.7% of survivors, 5.6% of live births) and the cerebral palsy rate for infants with birthweight 751-1000 g decreased. The proportion of survivors considered to be normal or mild disabled increased and the part suffering from moderate or severe disability decreased significantly.

CONCLUSIONS

In spite of long distances and unfavourable climatic conditions VLBW infants can be adequately cared for in this sparsely populated region of Norway.

The use of CRIB (clinical risk index for babies) score in auditing the performance of one neonatal intensive care unit

The CRIB (clinical risk index of babies) score was developed to overcome the disadvantages of birthweight-specific comparisons between neonatal units. The aims of this study were to assess the ability of CRIB score compared to birthweight and gestational age to predict hospital mortality in very low birthweight infants and to use CRIB score in auditing one unit's performance during a prolonged time period. The charts of 335 infants with birthweight < or = 1500 g born between 1980 and 1995 were reviewed retrospectively. CRIB predicted hospital mortality significantly better than birthweight and gestation and performed equally well, whether the infants were treated with synthetic surfactant or not. When adjusting for CRIB score there was a significant improvement in the unit's performance, probably owing to the introduction of surfactant. As small samples tend to be associated with wide confidence intervals, use of CRIB is recommended in comparing risk adjusted mortality in a single unit over several years, as in this study, or between large groups of neonatal units over shorter periods.