- Extremely low birth weight infant
- Neurodevelopmental outcome
- Severe disability
- Vermont Oxford Network
Background: Physicians and parents face significant uncertainties when making care decisions for extremely low birth weight (ELBW) infants. Many published estimates of death and developmental outcome are from well-funded university programs and may not reflect outcomes of infants from a variety of settings. The best estimates of the probabilities of death and severe disability combine local experience and published data. Objective: To describe the neurodevelopmental outcome of ELBW infants from centers of the ELBW Infant Follow-Up Group of the Vermont Oxford Network (VON) and to identify characteristics associated with severe disability. Methods: Predefined measures of living situation, health and developmental outcome were collected at 18–24 months’ corrected age for infants born from July 1, 1998 to December 31, 2003 with birth weights of 401–1,000 g at 33 North American VON centers. Logistic regression was used to identify characteristics associated with severe disability. Results: 6,198 ELBW infants were born and survived until hospital discharge; by the time of follow-up, 88 infants (1.4%) had died. Of the remaining 6,110 infants, 3,567 (58.4%) were evaluated. Severe disability occurred in 34% of the assessed infants. Multivariate logistic regression suggested cystic periventricular leukomalacia, congenital malformation and severe intraventricular hemorrhage were the characteristics most highly associated with severe disability. There were marked variations among the follow-up clinics in the attrition rate. Conclusion: ELBW infants completing evaluation were at a high risk for severe disability. There are considerable differences among participating centers in attrition at follow-up. Further resources will be needed to study the effect of follow-up care for this group of infants.
Copyright © 2009 S. Karger AG, Basel
- The Investigators of the Vermont-Oxford Trials Network Database Project: The Vermont-Oxford Trials Network: very low birth weight outcomes for 1990. Pediatrics 1993;91:540–545.
- Horbar JD, Badger GJ, Lewit EM, Rogowski J, Shiono P: Hospital and patient characteristics associated with variation in 28-day mortality rates for very low birth weight infants. Vermont Oxford Network. Pediatrics 1997;99:149–156.
- Horbar JD, Badger GJ, Carpenter JH, Fanaroff AA, Kilpatrick S, LaCorte M, Phibbs R, Soll R, Members of the Vermont Oxford Network: Trends in mortality and morbidity for very low birth weight infants, 1991–1999. Pediatrics 2002;110:143–151.
- Vohr BR, Wright LL, Dusick AM, Mele L, Verter J, Steichen JJ, Simon NP, Wilson DC, Broyles S, Bauer CR, Delaney-Black V, Yolton KA, Fleisher BE, Papile LA, Kaplan MD: 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.
- Hintz SR, Kendrick DE, Vohr BR, Poole WK, Higgins RD, National Institute of Child Health and Human Development Neonatal Research Network: Changes in neurodevelopmental outcomes at 18 to 22 months’ corrected age among infants of less than 25 weeks’ gestational age born in 1993–1999. Pediatrics 2005;115:1645–1651.
- Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR: Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. N Engl J Med 2000;343:378–384.
- Costeloe K, Hennessy E, Gibson AT, Marlow N, Wilkinson AR: The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 2000;106:659–671.
- Tommiska V, Heinonen K, Kero P, Pokela ML, Tammela O, Järvenpää AL, Salokorpi T, Virtanen M, Fellman V: A national two year follow up study of extremely low birthweight infants born in 1996–1997. Arch Dis Child Fetal Neonatal Ed 2003;88:F29–F35.
- Doyle LW, Victorian Infant Collaborative Study Group: Evaluation of neonatal intensive care for extremely low birth weight infants in Victoria over two decades. I. Effectiveness. Pediatrics 2004;113:505–509.
- Fily A, Pierrat V, Delporte V, Breart G, Truffert P, EPIPAGE Nord-Pas-de-Calais Study Group: Factors associated with neurodevelopmental outcome at 2 years after very preterm birth: the population-based Nord-Pas-de-Calais EPIPAGE cohort. Pediatrics 2006;117:357–366.
- Bayley N: Bayley Scales of Infant Development-II. San Antonio, Psychological Corp., 1993.
- Agarwal P, Lim SB: Long-term follow-up and outcome of extremely-low-birth-weight (ELBW) infants. Ann Acad Med Singapore 2003;32:346–353.
- Vermont Oxford Network Extremely Low Birth Weight Infant Follow-Up Project Manual of Operations, Release 5.0. Burlington, Vermont Oxford Network, 1998.
- National Center for Health Statistics. CDC Growth Charts: United States. The Percentile Data Files with LMS Values Page. http://www.cdc.gov/nchs/about/major/nhanes/growthcharts/datafiles.htm (accessed October 29, 2008).
- Schmidt B, Davis P, Moddemann D, Ohlsson A, Roberts RS, Saigal S, Solimano A, Vincer M, Wright LL, Trial of Indomethacin Prophylaxis in Preterms Investigators: Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants. N Engl J Med 2001;344:1966–1972.
- Vermont Oxford Network Database Manual of Operations: Release 6.0. Burlington, Vermont Oxford Network, 2001.
- McDonald H, American Academy of Pediatrics, Committee on Fetus and Newborn: Perinatal care at the threshold of viability. Pediatrics 2002;110:1024–1027.
- American Academy of Pediatrics, Committee on Fetus and Newborn: Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics 2007;119:401–403.
- Rüdiger M, Iffländer S, Reichert J, Bätzel C, Reiter G, Wauer RR: Which information will be given to parents of preterm infants – a comparison of estimates and local data. J Perinat Med 2007;35:436–442.
- Wariyar UK, Richmond S: Morbidity and preterm delivery: importance of 100% follow-up. Lancet 1989;1:387–388.
- Wolke D, Söhne B, Ohrt B, Riegel K: Follow-up of preterm children: important to document dropouts. Lancet 1995;345:447.
- Callanan C, Doyle L, Rickards A, Kelly E, Ford G, Davis N: Children followed with difficulty: how do they differ? J Paediatr Child Health 2001;37:152–156.
- Catlett AT, Thompson RJ Jr, Johndrow DA, Boshkoff MR: Risk status for dropping out of developmental followup for very low birth weight infants. Public Health Rep 1993;108:589–594.
- Aylward GP, Hatcher RP, Stripp B, Gustafson NF, Leavitt LA: Who goes and who stays: subject loss in a multicenter, longitudinal follow-up study. J Dev Behav Pediatr 1985;6:3–8.
- Castro L, Yolton K, Haberman B, Roberto N, Hansen N, Ambalavanan N, Vohr BR, Donovan EF: Bias in reported neurodevelopmental outcomes among extremely low birth weight survivors. Pediatrics 2004;114:404–410.
- Walsh MC, Yao Q, Horbar JD, Carpenter JH, Lee SK, Ohlsson A: Changes in the use of postnatal steroids for bronchopulmonary dysplasia in 3 large neonatal networks. Pediatrics 2006;118:e1328–e1335.
- Committee on Fetus and Newborn: Postnatal corticosteroids to treat or prevent chronic lung disease in preterm infants. Pediatrics 2002;109:330–338.
- Bolisetty S, Bajuk B, Me A-L, Vincent T, Sutton L, Lui K: Preterm outcome table (POT): a simple tool to aid counseling parents of very preterm infants. Aust N Z J Obstet Gynaecol 2006;46:189–192.
- Pritchard MA, Colditz PB, Beller EM, Queensland Optimising Preterm Infant Outcomes Group: Parents’ evaluation of developmental status in children born with a birthweight of 1,250 g or less. J Paediatr Child Health 2005;41:191–196.
- Fooks J: Four key questions that identify severe disability. Arch Dis Child 1999;80:67–68.
Charles E. Mercier, MD
Smith 578 MCHV Campus, Fletcher Allen Health Care
111 Colchester Avenue
Burlington, VT 05401 (USA)
Tel. +1 802 847 2495, Fax +1 802 847 5225, E-Mail email@example.com
Received: February 14, 2009
Accepted after revision: July 20, 2009
Published online: November 24, 2009
Number of Print Pages : 10
Number of Figures : 3, Number of Tables : 5, Number of References : 30
Neonatology (Fetal and Neonatal Research)
Vol. 97, No. 4, Year 2010 (Cover Date: June 2010)
Journal Editor: Halliday H.L. (Belfast), Speer C.P. (Würzburg)
ISSN: 1661-7800 (Print), eISSN: 1661-7819 (Online)
For additional information: http://www.karger.com/NEO
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.