243 EXTREMELY LOW BIRTKWEIGHT INFANTS; PREDICTION OF OUTCOME AT 5 YEARS

Abstract

Improved prenatal and neonatal care have contributed to the increased survival of VLBW. The tiny infants, however, have an increased risk of later sequaleae, such as cerebral plasy, retinopathy, schoold difficulties and chronic lung disease. These sequaleae are a great concern for both the parents and the society. The purpose of this study was to analyse the neonalal risk factors to these problems in extremely low birthweight (<1000 g) infants.During the period 1982-1987 96 (56%) ELBWI survived at the NICU of Children's Hospital. University of Helsinki. At five years of age all children underwent neuropsychological testing and a neurological investigation. The data about the neonatal period were collected retrospectively. They included the social background of the family, duration of the pregnancy and birthweight, several parameters from the first day of life and from the NICU treatment.The CRIB score was calculated from these data to all infants. Cranial ultrasound examination was performed several times to all infants.Of the infants 11 % had neurological abnormalities, 16% had retinopathy, 19% had emotional disturbances, 17% had delayed verbal development, 32% had visuomotor abnormalities and 20% had slight to severe intellectual impairment. All these aspect were normal in 53% of the infants. Intellectual impairment was associated with low gestational age, low birthweight, long respirator care, long oxygen demand, sepsis during the NICU care, severe IVH, and also with high CRIB score. Logistic regression analysis indicates that sepsis and third grade IVH were most important of these. Other outcome variables showed similar associations. However, neurological abnormalities were associated only with severe, fourth grade IVH.