Skip to main content
NCBI home page
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1997 Sep;77(2):F95–F99. doi: 10.1136/fn.77.2.f95

Influence of obstetric management on outcome of extremely preterm growth retarded infants

A Schaap, H Wolf, H Bruinse, A L den Ouden, H Haas, I van Ertbruggen, P Treffers
PMCID: PMC1720697  PMID: 9377153

Abstract

AIM—To describe the long term outcome of extremely preterm growth retarded infants in relation to obstetric management and various perinatal events.
METHODS—A cohort study was undertaken in two tertiary care centres with different obstetric management. All infants with fetal growth retardation due to placental insufficiency and resulting in fetal distress at 26 to 32 weeks of gestation, were included for the years 1984-89. Main outcome measures were impairment, disability, or handicap at 2 years corrected age and at school age (4 1/2 to 10 1/2 years).
RESULTS—One hundred and twenty five (98%) were followed up until 2 years corrected age in the outpatient department; 114 (90%) were assessed at school age. Impairments were found in 37% and disabilities or handicaps in 9% of the assessed infants, with no difference between centres. All disabled or handicapped children had already been identified by 2 years corrected age.
CONCLUSIONS—Disability or handicap were related to neonatal complications (intracerebral haemorrhage or bronchopulmonary dysplasia) and not to obstetric variables, thus making antenatal prediction impossible. The incidence of disability or handicap in these growth retarded infants was comparable with that of other preterm infants.

 Keywords: growth retardation; disability; handicap; obstetric variables

Full Text

The Full Text of this article is available as a PDF (121.0 KB).

Figure 1  .

Figure 1  

Open in a new tab

Mortality and disability/handicap for all liveborn infants followed up (n=166), and subdivided for the study. The total number of each subgroup is specified.

Figure 2  .

Figure 2  

Open in a new tab

Mortality and disability/handicap in all liveborn infants followed up (n=166), subdivided for birthweight (g). Total number of each subgroup is specified.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anton B. S., Dindia G. Parental perception of cognitive abilities of children with cerebral palsy. Psychol Rep. 1984 Jun;54(3):987–990. doi: 10.2466/pr0.1984.54.3.987. [DOI] [PubMed] [Google Scholar]
  2. Avery G. B. Ethical dilemmas in the treatment of the extremely low birth weight infant. Clin Perinatol. 1987 Jun;14(2):361–365. [PubMed] [Google Scholar]
  3. Beckman P. J. Perceptions of young children with handicaps: a comparison of mothers and program staff. Ment Retard. 1984 Aug;22(4):176–181. [PubMed] [Google Scholar]
  4. Britton S. B., Fitzhardinge P. M., Ashby S. Is intensive care justified for infants weighing less than 801 gm at birth? J Pediatr. 1981 Dec;99(6):937–943. doi: 10.1016/s0022-3476(81)80028-5. [DOI] [PubMed] [Google Scholar]
  5. Chalmers I., Mutch L. Are current trends in perinatal practice associated with an increase or a decrease in handicapping conditions? Lancet. 1981 Jun 27;1(8235):1415–1415. doi: 10.1016/s0140-6736(81)92585-x. [DOI] [PubMed] [Google Scholar]
  6. Ehrenhaft P. M., Wagner J. L., Herdman R. C. Changing prognosis for very low birth weight infants. Obstet Gynecol. 1989 Sep;74(3 Pt 2):528–535. [PubMed] [Google Scholar]
  7. Escobar G. J., Littenberg B., Petitti D. B. Outcome among surviving very low birthweight infants: a meta-analysis. Arch Dis Child. 1991 Feb;66(2):204–211. doi: 10.1136/adc.66.2.204. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fetter W. P., Baerts W., Borst L. E. Late morbiditeit bij kinderen met een geboortegewicht van minder dan 1500 gram, geboren in de periode 1979-1983. Ned Tijdschr Geneeskd. 1986 Jun 21;130(25):1143–1146. [PubMed] [Google Scholar]
  9. Gorter K. A. Survey methods for the assessment of physical disability among children. Disabil Rehabil. 1993 Jan-Mar;15(1):47–51. doi: 10.3109/09638289309165871. [DOI] [PubMed] [Google Scholar]
  10. Graham M., Levene M. I., Trounce J. Q., Rutter N. Prediction of cerebral palsy in very low birthweight infants: prospective ultrasound study. Lancet. 1987 Sep 12;2(8559):593–596. doi: 10.1016/s0140-6736(87)92986-2. [DOI] [PubMed] [Google Scholar]
  11. Hack M., Fanaroff A. A. Changes in the delivery room care of the extremely small infant (less than 750 g). Effects on morbidity and outcome. N Engl J Med. 1986 Mar 6;314(10):660–664. doi: 10.1056/NEJM198603063141036. [DOI] [PubMed] [Google Scholar]
  12. Hagberg B., Hagberg G., Olow I., von Wendt L. The changing panorama of cerebral palsy in Sweden. V. The birth year period 1979-82. Acta Paediatr Scand. 1989 Mar;78(2):283–290. doi: 10.1111/j.1651-2227.1989.tb11071.x. [DOI] [PubMed] [Google Scholar]
  13. Hille E. T., den Ouden A. L., Bauer L., van den Oudenrijn C., Brand R., Verloove-Vanhorick S. P. School performance at nine years of age in very premature and very low birth weight infants: perinatal risk factors and predictors at five years of age. Collaborative Project on Preterm and Small for Gestational Age (POPS) Infants in The Netherlands. J Pediatr. 1994 Sep;125(3):426–434. doi: 10.1016/s0022-3476(05)83290-1. [DOI] [PubMed] [Google Scholar]
  14. Hirata T., Epcar J. T., Walsh A., Mednick J., Harris M., McGinnis M. S., Sehring S., Papedo G. Survival and outcome of infants 501 to 750 gm: a six-year experience. J Pediatr. 1983 May;102(5):741–748. doi: 10.1016/s0022-3476(83)80250-9. [DOI] [PubMed] [Google Scholar]
  15. Johnson A., Townshend P., Yudkin P., Bull D., Wilkinson A. R. Functional abilities at age 4 years of children born before 29 weeks of gestation. BMJ. 1993 Jun 26;306(6894):1715–1718. doi: 10.1136/bmj.306.6894.1715. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Johnson M. A., MacFarlane A. J. Neonatal intensive care: trends in morbidity. Lancet. 1988 Jul 16;2(8603):168–168. doi: 10.1016/s0140-6736(88)90724-6. [DOI] [PubMed] [Google Scholar]
  17. Kitchen W. H., Ford G. W., Rickards A. L., Lissenden J. V., Ryan M. M. Children of birth weight less than 1000 g: changing outcome between ages 2 and 5 years. J Pediatr. 1987 Feb;110(2):283–288. doi: 10.1016/s0022-3476(87)80174-9. [DOI] [PubMed] [Google Scholar]
  18. Kitchen W., Ford G., Orgill A., Rickards A., Astbury J., Lissenden J., Bajuk B., Yu V., Drew J., Campbell N. Outcome in infants of birth weight 500 to 999 g: a continuing regional study of 5-year-old survivors. J Pediatr. 1987 Nov;111(5):761–766. doi: 10.1016/s0022-3476(87)80264-0. [DOI] [PubMed] [Google Scholar]
  19. Levy S. E., Hyman S. L. Pediatric assessment of the child with developmental delay. Pediatr Clin North Am. 1993 Jun;40(3):465–477. doi: 10.1016/s0031-3955(16)38544-3. [DOI] [PubMed] [Google Scholar]
  20. Michelsson K., Lindahl E., Parre M., Helenius M. Nine-year follow-up of infants weighing 1 500 g or less at birth. Acta Paediatr Scand. 1984 Nov;73(6):835–841. doi: 10.1111/j.1651-2227.1984.tb17784.x. [DOI] [PubMed] [Google Scholar]
  21. Palfrey J. S., Singer J. D., Walker D. K., Butler J. A. Early identification of children's special needs: a study in five metropolitan communities. J Pediatr. 1987 Nov;111(5):651–659. doi: 10.1016/s0022-3476(87)80238-x. [DOI] [PubMed] [Google Scholar]
  22. Pharoah P. O., Stevenson C. J., Cooke R. W., Stevenson R. C. Clinical and subclinical deficits at 8 years in a geographically defined cohort of low birthweight infants. Arch Dis Child. 1994 Apr;70(4):264–270. doi: 10.1136/adc.70.4.264. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Ross G., Lipper E. G., Auld P. A. Consistency and change in the development of premature infants weighing less than 1,501 grams at birth. Pediatrics. 1985 Dec;76(6):885–891. [PubMed] [Google Scholar]
  24. Ross G., Lipper E. G., Auld P. A. Social competence and behavior problems in premature children at school age. Pediatrics. 1990 Sep;86(3):391–397. [PubMed] [Google Scholar]
  25. Ruys-Dudok van Heel I., de Leeuw R. Clinical outcome of small for gestational age preterm infants. J Perinat Med. 1989;17(2):77–83. doi: 10.1515/jpme.1989.17.2.77. [DOI] [PubMed] [Google Scholar]
  26. Saigal S., Rosenbaum P., Hattersley B., Milner R. Decreased disability rate among 3-year-old survivors weighing 501 to 1000 grams at birth and born to residents of a geographically defined region from 1981 to 1984 compared with 1977 to 1980. J Pediatr. 1989 May;114(5):839–846. doi: 10.1016/s0022-3476(89)80150-7. [DOI] [PubMed] [Google Scholar]
  27. Saigal S., Rosenbaum P., Stoskopf B., Milner R. Follow-up of infants 501 to 1,500 gm birth weight delivered to residents of a geographically defined region with perinatal intensive care facilities. J Pediatr. 1982 Apr;100(4):606–613. doi: 10.1016/s0022-3476(82)80767-1. [DOI] [PubMed] [Google Scholar]
  28. Saigal S., Rosenbaum P., Szatmari P., Campbell D. Learning disabilities and school problems in a regional cohort of extremely low birth weight (less than 1000 G) children: a comparison with term controls. J Dev Behav Pediatr. 1991 Oct;12(5):294–300. [PubMed] [Google Scholar]
  29. Schaap A. H., Wolf H., Bruinse H. W., de Leeuw R., van Ertbruggen I., Treffers P. E. Fetal distress due to placental insufficiency at 26 through 31 weeks: a comparison between an active and a more conservative management. Eur J Obstet Gynecol Reprod Biol. 1996 Dec;70(1):61–68. doi: 10.1016/s0301-2115(96)02560-2. [DOI] [PubMed] [Google Scholar]
  30. Scherjon S. A., Smolders-DeHaas H., Kok J. H., Zondervan H. A. The "brain-sparing" effect: antenatal cerebral Doppler findings in relation to neurologic outcome in very preterm infants. Am J Obstet Gynecol. 1993 Jul;169(1):169–175. doi: 10.1016/0002-9378(93)90156-d. [DOI] [PubMed] [Google Scholar]
  31. Stewart A. L., Thorburn R. J., Hope P. L., Goldsmith M., Lipscomb A. P., Reynolds E. O. Ultrasound appearance of the brain in very preterm infants and neurodevelopmental outcome at 18 months of age. Arch Dis Child. 1983 Aug;58(8):598–604. doi: 10.1136/adc.58.8.598. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Touwen B. C. Very low birth weight infants. Eur J Pediatr. 1986 Dec;145(6):460–460. doi: 10.1007/BF02429042. [DOI] [PubMed] [Google Scholar]
  33. Tyson J. E., Lasky R. E., Rosenfeld C. R., Dowling S., Gant N., Jr An analysis of potential biases in the loss of indigent infants to follow-up. Early Hum Dev. 1988 Jan;16(1):13–25. doi: 10.1016/0378-3782(88)90083-7. [DOI] [PubMed] [Google Scholar]
  34. Wariyar U. K., Richmond S. Morbidity and preterm delivery: importance of 100% follow-up. Lancet. 1989 Feb 18;1(8634):387–388. doi: 10.1016/s0140-6736(89)91764-9. [DOI] [PubMed] [Google Scholar]
  35. Weisglas-Kuperus N., Baerts W., Sauer P. J. Early assessment and neurodevelopmental outcome in very low-birth-weight infants: implications for pediatric practice. Acta Paediatr. 1993 May;82(5):449–453. doi: 10.1111/j.1651-2227.1993.tb12720.x. [DOI] [PubMed] [Google Scholar]
  36. Weisglas-Kuperus N., Uleman-Vleeschdrager M., Baerts W. Ventricular haemorrhages and hypoxic-ischaemic lesions in preterm infants: neurodevelopmental outcome at 3 1/2 years. Dev Med Child Neurol. 1987 Oct;29(5):623–629. doi: 10.1111/j.1469-8749.1987.tb08504.x. [DOI] [PubMed] [Google Scholar]
  37. van Zeben-van der Aa T. M., Verloove-Vanhorick S. P., Brand R., Ruys J. H. Morbidity of very low birthweight infants at corrected age of two years in a geographically defined population. Report from Project on Preterm and Small for gestational age infants in The Netherlands. Lancet. 1989 Feb 4;1(8632):253–255. doi: 10.1016/s0140-6736(89)91265-8. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood Fetal and Neonatal Edition are provided here courtesy of BMJ Publishing Group

RESOURCES