Population based trends in mortality, morbidity and treatment for very preterm- and very low birth weight infants over 12 years

BACKGROUND: Over the last two decades, improvements in medical care have been associated with a significant increase and better outcome of very preterm (VP, < 32 completed gestational weeks) and very low birth weight (VLBW, < 1500 g) infants. Only a few publications analyse changes of their short-term outcome in a geographically defined area over more than 10 years. We therefore aimed to investigate the net change of VP- and VLBW infants leaving the hospital without major complications. METHODS: Our population-based observational cohort study used the Minimal Neonatal Data Set, a database maintained by the Swiss Society of Neonatology including information of all VP- and VLBW infants. Perinatal characteristics, mortality and morbidity rates and the survival free of major complications were analysed and their temporal trends evaluated. RESULTS: In 1996, 2000, 2004, and 2008, a total number of 3090 infants were enrolled in the Network Database. At the same time the rate of VP- and VLBW neonates increased significantly from 0.87% in 1996 to 1.10% in 2008 (p < 0.001). The overall mortality remained stable by 13%, but the survival free of major complications increased from 66.9% to 71.7% (p < 0.01). The percentage of infants getting a full course of antenatal corticosteroids increased from 67.7% in 1996 to 91.4% in 2008 (p < 0.001). Surfactant was given more frequently (24.8% in 1996 compared to 40.1% in 2008, p < 0.001) and the frequency of mechanical ventilation remained stable by about 43%. However, the use of CPAP therapy increased considerably from 43% to 73.2% (p < 0.001). Some of the typical neonatal pathologies like bronchopulmonary dysplasia, necrotising enterocolitis and intraventricular haemorrhage decreased significantly (p ≤ 0.02) whereas others like patent ductus arteriosus and respiratory distress syndrome increased (p < 0.001). CONCLUSIONS: Over the 12-year observation period, the number of VP- and VLBW infants increased significantly. An unchanged overall mortality rate and an increase of survivors free of major complication resulted in a considerable net gain in infants with potentially good outcome

Is hypotension a major risk factor for neurological morbidity at term age in very preterm infants?

Objective: To investigate the influence of perinatal risk factors, especially hypotension, on neuromotor status at term in surviving preterm infants born before 32 weeks of gestation. Methods: This study is part of the Leiden Follow-Up Project on Prematurity: a prospective, regional study of 266 live born infants with a gestational age (GA

Clinical assessment of language development in children at age 3 years that were born preterm Avaliação da evolução dos aspectos linguísticos em crianças que nasceram prematuras aos 3 anos de idade

OBJECTIVE: To evaluate the influence of gestational age and birth weight on language development and neurodevelopmental outcome at age 3 years in children born preterm. METHOD: Cross sectional study including 69 children followed in our developmental outpatient clinic. Patients were consecutively included at the time of the 3 years of age appointment and stratified for birth weight (<1500 grams and between 1500-2500 grams). All patients were assessed for receptive and expressive language , Denver II and Bayley II tests and clinical neurological examination. For analysis patients were divided in two groups normal language acquisition (NLA) and delay in language acquisition (DLA). RESULTS: NLA children had higher scores on mental and psychomotor (p=<0.01, p=0.012) indexes of Bayley II. Newborns with less than 1500 grams had lower scores on all Bayley scale at age 36 months (p=0.002, p=0.007 and p<0.001). Multivariate analysis suggests an association between gestational age (p=0.032), abnormal behavior (p<0.001) and delay in language acquisition. Denver test at 12 and 24 months of age was a good predictor of delayed receptive and expressive language at three years of age (p=<0.01 and p=<0.01). CONCLUSION: Children born prematurely with low birth weight had an increased risk of language acquisition delay, and those had also lower cognitive and behavior scores when compared to NLA.<br>OBJETIVO: Avaliar influência da idade gestacional (IG) e peso ao nascimento na aquisição da linguagem e neurodesenvolvimento em crianças de 3 anos que nasceram prematuras. MÉTODO: Estudo transversal incluindo 69 crianças acompanhadas no Ambulatório de Seguimento Neonatal. Pacientes incluídos tinham 3 anos e foram estratificados por peso ao nascimento (>1500 gramas e entre 1500-2500 gramas). Todos foram avaliados com relação ao neurodesenvolvimento incluindo avaliação neurológica clínica, Denver II, Bayley II e avaliação da linguagem. Para a analise dividimos em dois grupos com e sem alteração na aquisição de linguagem. RESULTADOS: Crianças com DAL apresentam melhores índices nos escores de desenvolvimento no Bayley II (p=<0.01 e p=0.012). Crianças que nasceram com peso >1500 gramas tiveram escores menores no Bayley II na idade de 36 m (p=0.002, p=0.007 e p<0.001). Análise multivariada sugere uma associação da IG (p=0,032) e alteração comportamental (p=0,001) com atraso na aquisição da linguagem. Denver II alterado tanto aos 12 m quanto aos 24 m, correlaciona-se com significância estatística a atraso na aquisição de linguagem receptiva e expressiva aos 3 anos de idade (p=<0.01 e p=<0.01). CONCLUSÃO: Crianças nascidas prematuras e com baixo peso ao nascimento, apresentam maior risco de ter um atraso no desenvolvimento da linguagem. Sendo que as crianças que tem atraso no desenvolvimento de linguagem apresentaram um desempenho cognitivo e psicomotor inferior ao das com desenvolvimento normal