Premature Infant Outcomes
Linda Wallen, MD
Prevalence of Cerebral Palsy
VLBW Infants - 1982-1994
Mortality
(% live births)
Cerebral Palsy
(% survivors)
1982-1984
36.8
9.1
1984-1986
31.5
12.3
1986-1988
36.1
11.9
1988-1990
29.2
9.2
1990-1992
21.8
3.6
1992-1994
13.8
6.6
(O’Shea et al., 1998)
Survival & Outcome of Infants Weighing <800 g
1979 to 1994
Dates
(n)
Survival
CLD
G 3 IVH/IPE Rehospital
% (n) (% surv) (% surv) (% surv 1 yr)
1979-1984
(120)
20 (24)
23
10
29
1984-1989
(175)
36 (63)
66
21
49
1989-1994
(218)
59 (129)
61
12
53
(O’Shea et al., Pediatrics 100: 982-986, 1997)
Survival & Outcome of Infants, 401-1250 g
1994 to 1996
BW (g)
(n)
Survival Severe IVH % w/o Sev IVH
% (n)
(n)
%
(n)
401-500
(497)
17
501-750
(5334)
60 (3110)
380
52 (2730)
751-1000
(6336)
89 (5501)
370
82 (5131)
1001-1250
(7201)
96 (6739)
285
92 (6454)
(82)
6
15
(Finer et al., Pediatrics 104: 428-434, 1999)
(76)
Survival & Outcome of Infants, < 1250 g
Doernbecher NCC, 1995 to 1998
BW (g)
(n)
< 500 g
(11)
500-749
(57)
Survival
% (n)
63 (7)
Severe
IVH (n)
0
72 (41)
5
750-999
(104)
94 (98)
11
1000-1249
(107)
96 (103)
10
Bayley Scales at 30 Months for Infants Born at
< 26 Weeks Gestation
Individual Scores on Bayley Scales at 30 months by Gestational Age
(EPIcure Group (UK) follow up Mar-Dec 1995. New England J Med 343:381, 2000)
Risk Factors for Cerebral Palsy in Infants
< 1000 g at 18-22 Months
Adj. Risk for No Independent Walking
Adj. Risk for No Independent Feeding
From NICHD Network 1993-1994 Follow-Up. Pediatrics. 105:1221-22, 2000.
Risk Factors for Severe Developmental Delay
in Infants <1000 g at 18-22 Months
Adjusted Risk Factors for MDI < 70
Adjusted Risk Factors for PDI < 70
From NICHD Network 1993-1994 Follow-Up. Pediatrics. 105:1220-21, 2000.
30 Month Outcome for Infants Born at < 26 Weeks
No data (1%)
Died (2%)
Severe
disability (25%)
No disability
(49%)
Other disability
(25%)
(EPIcure Group (UK) follow up Mar-Dec 1995. New England J Med 343:381, 2000)
NICHD Outcome of Infants 401-1000 g at Discharge
BW (g) (n)
Post-Neo
Survival %
CLD
%
Steroid Grade 3-4 Hosp d
Rx % IVH/PVL % Median
501-600 (94)
98
51
68
16
119
601-700 (205)
96
49
59
23
109
701-800 (227)
98
45
50
22
99
801-900 (276)
97
36
38
18
84
901-1000 (295)
96
30
28
15
73
401-1000 (1111)
97
40
44
18
92
From NICHD Network 1993-1994 Follow-Up. Pediatrics. 105:1221-22, 2000.
NICHD Outcome of Infants 401-1000 g at 18 Months
BW (g) (n)
CP
%
Blind Hearing Normal
%
Loss % Exam %
501-600 (94)
17
10
11
71
601-700 (205)
21
12
14
70
701-800 (227)
17
13
9
72
801-900 (276)
15
5
9
79
901-1000 (295)
15
5
7
79
401-1000 (1111)
17
9
11
75
From NICHD Network 1993-1994 Follow-Up. Pediatrics. 105:1221-22, 2000.
NICHD Outcome of Infants 401-1000 g at18 Months
BW (g) (n)
501-600 (94)
MDI
PDI
MDI %
PDI %
Mn (SD) Mn (SD) < 70 <85 < 70 <85
73 (16) 75 (19)
45
70
34
65
601-700 (205)
74 (16)
76 (19)
41
72
35
62
701-800 (227)
74 (17)
77 (18)
42
68
31
50
801-900 (276)
77 (17)
80 (18)
35
67
25
52
901-1000 (295)
79 (18)
80 (18)
31
58
25
53
401-1000 (1111)
76 (17)
78 (18)
37
66
29
57
From NICHD Network 1993-1994 Follow-Up. Pediatrics. 105:1221-22, 2000.
Growth Failure in the ELBW Infant



Growth at 1 yr of infants 501-800 g born 1989-1994
– Head circumference < 10% = 35% (45/219)
– Weight < 10% = 58% (75/219)
– Length < 10% = 33% (42/219)
Growth at 6-7 yr of infants < 750 g born 1982-86
– Head circumference < 3% = 35% (24/68)
– Weight < 3% = 22% (15/68)
– Height < 3% = 25% (17/68)
Growth at 6-7 yr of infants 750-1499 g born 1982-86
– Head circumference < 3% = 14% (9/65)
– Weight < 3% = 11% (7/65)
– Height < 3% = 5% (3/65)
Outcomes of ELBW infants



Historical reasons for reliance on neurologic morbidities
– Public misperception of prevalence of severe disability
– Limitation of range of outcomes studied
Other health outcomes that are affected
– Increased incidence of asthma
– Increased visual perceptual & expressive language disabilities
– Increased behavioral problems
– Growth failure
– Family and child perception of health and outcome
– Psychological outcomes
Other factors which influence outcome = risk factors and post discharge
environment, heavily influenced by maternal education, income level,
smoking, poor maternal health (physical or mental)