Skip to main content
PMC home page
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 2003 Jan;88(1):F29–F35. doi: 10.1136/fn.88.1.F29

A national two year follow up study of extremely low birthweight infants born in 1996–1997

V Tommiska, K Heinonen, P Kero, M Pokela, O Tammela, A Jarvenpaa, T Salokorpi, M Virtanen, V Fellman, N Marlow
PMCID: PMC1756010  PMID: 12496223

Abstract

Objective: To study neurodevelopmental outcome in a two year cohort of extremely low birthweight (ELBW) infants at 18 months corrected age, to compare the development of the ELBW infant subcohort with that of control children, and to find risk factors associated with unfavourable outcome.

Study design: All 211 surviving ELBW infants (birth weight < 1000 g) born in Finland in 1996–1997 were included in a national survey. The ELBW infants (n = 78) who were born and followed in Helsinki University Hospital belonged to a regional subcohort and were compared with a control group of 75 full term infants. A national follow up programme included neurological, speech, vision, and hearing assessments at 18 months of corrected age. Bayley infant scale assessment was performed on the subcohort and their controls at 24 months of age. Risk factors for unfavourable outcome were estimated using logistic and linear regression models.

Results: The prevalence of cerebral palsy was 11%, of all motor impairments 24%, of ophthalmic abnormalities 23%, and of speech delay 42%. No impairment was found in 42% of children, and 18% were classified as severely impaired. The prevalence of ophthalmic abnormalities decreased with increasing birth weight and gestational age, but the prevalence of other impairments did not. In the subcohort, a positive correlation was found between the date of birth and Bayley scores.

Conclusion: Ophthalmic abnormalities decreased with increasing birth weight and gestational age, but no other outcome differences were found between birthweight groups or in surviving ELBW infants born at 22–26 weeks gestation. The prognosis in the regional subcohort seemed to improve during the short study period, but this needs to be confirmed.

Full Text

The Full Text of this article is available as a PDF (193.3 KB).

Figure 1 .

Figure 1

Open in a new tab

Prevalence of (A) motor impairment, (B) delay in speech development, and (C) abnormalities in ophthalmic assessment at the corrected age of 18 months in different birthweight groups.

Figure 2 .

Figure 2

Open in a new tab

Stillbirth rate, two year mortality rate, prevalence of severe impairments, mild impairments, and normal development, and missing developmental data in extremely low birthweight infants born at 22–26 gestational weeks. Severe impairment was defined as cerebral palsy, blindness, hearing impairment necessitating hearing aid, seizures, or a combination of three or more milder impairments detected in the ophthalmic, hearing, motor, or speech assessment.

Selected References

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

  1. Akeson P. M., Axelsson I. E., Räihä N. C. Plasma lipids and apolipoproteins in breastfed and formula-fed Swedish infants. Acta Paediatr. 1999 Jan;88(1):1–6. doi: 10.1111/j.1651-2227.1999.tb01258.x. [DOI] [PubMed] [Google Scholar]
  2. Bell M. J., Ternberg J. L., Feigin R. D., Keating J. P., Marshall R., Barton L., Brotherton T. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978 Jan;187(1):1–7. doi: 10.1097/00000658-197801000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blaymore-Bier J., Pezzullo J., Kim E., Oh W., Garcia-Coll C., Vohr B. R. Outcome of extremely low-birth-weight infants: 1980-1990. Acta Paediatr. 1994 Dec;83(12):1244–1248. doi: 10.1111/j.1651-2227.1994.tb13005.x. [DOI] [PubMed] [Google Scholar]
  4. Bylund B., Cervin T., Finnström O., Gäddlin P. O., Kernell A., Leijon I., Sandstedt P., Wärngård O. Morbidity and neurological function of very low birthweight infants from the newborn period to 4 y of age. A prospective study from the south-east region of Sweden. Acta Paediatr. 1998 Jul;87(7):758–763. doi: 10.1080/080352598750013842. [DOI] [PubMed] [Google Scholar]
  5. Cooke R. W. Factors affecting survival and outcome at 3 years in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed. 1994 Jul;71(1):F28–F31. doi: 10.1136/fn.71.1.f28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Dezoete J. A., MacArthur B. A., Aftimos S. Developmental outcome at 18 months of children less than 1000 grams. N Z Med J. 1997 Jun 13;110(1045):205–207. [PubMed] [Google Scholar]
  7. Doyle L. W. Outcome to five years of age of children born at 24-26 weeks' gestational age in Victoria. The Victorian Infant Collaborative Study Group. Med J Aust. 1995 Jul 3;163(1):11–14. [PubMed] [Google Scholar]
  8. Emsley H. C., Wardle S. P., Sims D. G., Chiswick M. L., D'Souza S. W. Increased survival and deteriorating developmental outcome in 23 to 25 week old gestation infants, 1990-4 compared with 1984-9. Arch Dis Child Fetal Neonatal Ed. 1998 Mar;78(2):F99–104. doi: 10.1136/fn.78.2.f99. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Finnström O., Olausson P. O., Sedin G., Serenius F., Svenningsen N., Thiringer K., Tunell R., Wennergren M., Wesström G. The Swedish national prospective study on extremely low birthweight (ELBW) infants. Incidence, mortality, morbidity and survival in relation to level of care. Acta Paediatr. 1997 May;86(5):503–511. doi: 10.1111/j.1651-2227.1997.tb08921.x. [DOI] [PubMed] [Google Scholar]
  10. Finnström O., Otterblad Olausson P., Sedin G., Serenius F., Svenningsen N., Thiringer K., Tunell R., Wesström G. Neurosensory outcome and growth at three years in extremely low birthweight infants: follow-up results from the Swedish national prospective study. Acta Paediatr. 1998 Oct;87(10):1055–1060. doi: 10.1080/080352598750031374. [DOI] [PubMed] [Google Scholar]
  11. French N. P., Parry T. S., Evans S. Improving outcome for Western Australian infants with birthweights 500-999 g. Med J Aust. 1995 Mar 20;162(6):295-6, 298-9. doi: 10.5694/j.1326-5377.1995.tb139903.x. [DOI] [PubMed] [Google Scholar]
  12. Gissler M., Rahkonen O., Järvelin M. R., Hemminki E. Social class differences in health until the age of seven years among the Finnish 1987 birth cohort. Soc Sci Med. 1998 Jun;46(12):1543–1552. doi: 10.1016/s0277-9536(98)00013-6. [DOI] [PubMed] [Google Scholar]
  13. Hack M., Friedman H., Fanaroff A. A. Outcomes of extremely low birth weight infants. Pediatrics. 1996 Nov;98(5):931–937. [PubMed] [Google Scholar]
  14. Hack M., Taylor H. G., Klein N., Eiben R., Schatschneider C., Mercuri-Minich N. School-age outcomes in children with birth weights under 750 g. N Engl J Med. 1994 Sep 22;331(12):753–759. doi: 10.1056/NEJM199409223311201. [DOI] [PubMed] [Google Scholar]
  15. Hagberg B., Hagberg G., Olow I., von Wendt L. The changing panorama of cerebral palsy in Sweden. VII. Prevalence and origin in the birth year period 1987-90. Acta Paediatr. 1996 Aug;85(8):954–960. doi: 10.1111/j.1651-2227.1996.tb14193.x. [DOI] [PubMed] [Google Scholar]
  16. Halsey C. L., Collin M. F., Anderson C. L. Extremely low birth weight children and their peers: a comparison of preschool performance. Pediatrics. 1993 Apr;91(4):807–811. [PubMed] [Google Scholar]
  17. 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]
  18. Johnson A. Disability and perinatal care. Pediatrics. 1995 Feb;95(2):272–274. [PubMed] [Google Scholar]
  19. 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]
  20. Jones H. P., Guildea Z. E. S., Stewart J. H., Cartlidge P. H. T. The Health Status Questionnaire: achieving concordance with published disability criteria. Arch Dis Child. 2002 Jan;86(1):15–20. doi: 10.1136/adc.86.1.15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. 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]
  22. Klebanov P. K., Brooks-Gunn J., McCormick M. C. Classroom behavior of very low birth weight elementary school children. Pediatrics. 1994 Nov;94(5):700–708. [PubMed] [Google Scholar]
  23. Koller H., Lawson K., Rose S. A., Wallace I., McCarton C. Patterns of cognitive development in very low birth weight children during the first six years of life. Pediatrics. 1997 Mar;99(3):383–389. doi: 10.1542/peds.99.3.383. [DOI] [PubMed] [Google Scholar]
  24. La Pine T. R., Jackson J. C., Bennett F. C. Outcome of infants weighing less than 800 grams at birth: 15 years' experience. Pediatrics. 1995 Sep;96(3 Pt 1):479–483. [PubMed] [Google Scholar]
  25. Lefebvre F., Glorieux J., St-Laurent-Gagnon T. Neonatal survival and disability rate at age 18 months for infants born between 23 and 28 weeks of gestation. Am J Obstet Gynecol. 1996 Mar;174(3):833–838. doi: 10.1016/s0002-9378(96)70309-5. [DOI] [PubMed] [Google Scholar]
  26. Lorenz J. M., Paneth N., Jetton J. R., den Ouden L., Tyson J. E. Comparison of management strategies for extreme prematurity in New Jersey and the Netherlands: outcomes and resource expenditure. Pediatrics. 2001 Dec;108(6):1269–1274. doi: 10.1542/peds.108.6.1269. [DOI] [PubMed] [Google Scholar]
  27. O'Shea T. M., Klinepeter K. L., Goldstein D. J., Jackson B. W., Dillard R. G. Survival and developmental disability in infants with birth weights of 501 to 800 grams, born between 1979 and 1994. Pediatrics. 1997 Dec;100(6):982–986. doi: 10.1542/peds.100.6.982. [DOI] [PubMed] [Google Scholar]
  28. Papile L. A., Burstein J., Burstein R., Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978 Apr;92(4):529–534. doi: 10.1016/s0022-3476(78)80282-0. [DOI] [PubMed] [Google Scholar]
  29. Pennefather P. M., Clarke M. P., Strong N. P., Cottrell D. G., Fritz S., Tin W. Ocular outcome in children born before 32 weeks gestation. Eye (Lond) 1995;9(Pt 6 SU):26–30. [PubMed] [Google Scholar]
  30. Piecuch R. E., Leonard C. H., Cooper B. A., Kilpatrick S. J., Schlueter M. A., Sola A. Outcome of infants born at 24-26 weeks' gestation: II. Neurodevelopmental outcome. Obstet Gynecol. 1997 Nov;90(5):809–814. doi: 10.1016/S0029-7844(97)00429-8. [DOI] [PubMed] [Google Scholar]
  31. Piecuch R. E., Leonard C. H., Cooper B. A., Sehring S. A. Outcome of extremely low birth weight infants (500 to 999 grams) over a 12-year period. Pediatrics. 1997 Oct;100(4):633–639. doi: 10.1542/peds.100.4.633. [DOI] [PubMed] [Google Scholar]
  32. Pihkala J., Hakala T., Voutilainen P., Raivio K. Uudet suomalaiset sikiön kasvukäyrät. Duodecim. 1989;105(18):1540–1546. [PubMed] [Google Scholar]
  33. Robertson C., Sauve R. S., Christianson H. E. Province-based study of neurologic disability among survivors weighing 500 through 1249 grams at birth. Pediatrics. 1994 Apr;93(4):636–640. [PubMed] [Google Scholar]
  34. Saigal S., Hoult L. A., Streiner D. L., Stoskopf B. L., Rosenbaum P. L. School difficulties at adolescence in a regional cohort of children who were extremely low birth weight. Pediatrics. 2000 Feb;105(2):325–331. doi: 10.1542/peds.105.2.325. [DOI] [PubMed] [Google Scholar]
  35. Steinkuller P. G., Du L., Gilbert C., Foster A., Collins M. L., Coats D. K. Childhood blindness. J AAPOS. 1999 Feb;3(1):26–32. doi: 10.1016/s1091-8531(99)70091-1. [DOI] [PubMed] [Google Scholar]
  36. Stjernqvist K., Svenningsen N. W. Extremely low-birth-weight infants less than 901 g. Growth and development after one year of life. Acta Paediatr. 1993 Jan;82(1):40–44. doi: 10.1111/j.1651-2227.1993.tb12512.x. [DOI] [PubMed] [Google Scholar]
  37. Tin W., Fritz S., Wariyar U., Hey E. Outcome of very preterm birth: children reviewed with ease at 2 years differ from those followed up with difficulty. Arch Dis Child Fetal Neonatal Ed. 1998 Sep;79(2):F83–F87. doi: 10.1136/fn.79.2.f83. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Vohr B. R., Wright L. L., Dusick A. M., Mele L., Verter J., Steichen J. J., Simon N. P., Wilson D. C., Broyles S., Bauer C. R. 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 Jun;105(6):1216–1226. doi: 10.1542/peds.105.6.1216. [DOI] [PubMed] [Google Scholar]
  39. Wood N. S., Marlow N., Costeloe K., Gibson A. T., Wilkinson A. R. Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. N Engl J Med. 2000 Aug 10;343(6):378–384. doi: 10.1056/NEJM200008103430601. [DOI] [PubMed] [Google Scholar]

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

RESOURCES