Prematurity, “The Outcome”: The Past, the Present, and the Future

Abstract

Objective: to present a clinical opinion on the outcome of very low birthweight (less than 1,250 grams) babies based on statistics of early child development and personal experience accumulated over the past 25 years of work in neonatal follow-up.Methods: population-based long-term outcomes of all survivors with birthweights of below 1,250 grams from northern and central Alberta has been prospectively obtained since 1974 when modern neonatal intensive care began in this region. The proportion of neurodevelopmentally disabled survivors (cerebral palsy, mental retardation, vision and hearing loss) is recorded graphically by time period and gestational age.The incompleteness of this neurodevelopmental disability tally as the standard form of outcome measurement of low birthweight is discussed by reflecting upon the past and the future.Results: two thousand, six hundred and three neonates of less than 1,250 grams birthweight received tertiary neonatal intensive care in northern and central Alberta from 1975 through 1997. Survival increased from 45 to 81 percent during this period, freedom from disability increased from 31 to 61 percent, and those disabled increased from nine to 14 percent. Among survivors, cerebral palsy has decreased to five percent from a high of 13 percent, vision loss has decreased to 2.5 percent from eight percent; yet hearing loss has increased from 2.5 percent to four percent in recent years. Mental delay (mental developmental level of less than 70) has increased from 13 percent in 1975-78 to greater than 30 percent of survivors born in the mid 1990’s.Conclusion: cerebral palsy and visual impairment are decreasing in frequency among very preterm infants; however, mental delay is increasing. Neurodevelopmental follow-up needs to expand within neuropsychological, behavioural, and psychosocial sciences in order to develop ways to help these survivors reach their potential.