Mid- and long-term outcome of 89 premature infants weighing less than 1,000 g at birth, all appropriate for gestational age.
OBJECTIVE
Advances in obstetrical and neonatal care have achieved dramatic reductions in the mortality of extremely low birth weight infants, but concerns regarding the long-term neurodevelopmental prognosis have increased. The study was performed to assess the physical and developmental status of premature infants weighing < 1,000 g at birth who were appropriate for gestational age (AGA).


METHODS
A follow-up study including school level, physical and developmental examination and/or interviews of parents, pediatricians, teachers and social workers was carried out from January 1, 1981 to December 31, 1991, on 176 subjects who had been AGA premature neonates weighing < 1,000 g and were admitted to the Port Royal Neonatal Intensive Care Unit. Eighty-nine survived (50 girls, 39 boys). Five children were lost to follow-up after 3 years of age. Neurological sequelae, developmental and/or intellectual quotients, school level and results, vision, hearing, language, weight, height, and behavior were evaluated.


RESULTS
At the last evaluation, 37% of children were completely normal (24% had always been normal); 52% were normal in the 4th year of life, decreasing to 31% in the 8th year. Minor disabilities increased from 31% in the 4th year to 53% in the 8th year. Moderate disabilities ranged yearly between 8 and 14%. Five children had major handicaps diagnosed before 3 years of age (4 cerebral palsies following severe neonatal brain lesions and 1 severe retardation with renal dwarfism). No difference was found between children with or without bronchopulmonary dysplasia. Twelve children (14%) had hearing loss (3 deafness) and 27 (32%) had visual deficits (no blindness). Nursery school begins at 3 for French children: 86% of the followed survivors were at nursery school at 3 years of age, 74% of 6-year-olds were in the first grade, primary school, and 50% of 7-year-olds were in second grade. Half the children with high socioeconomic/cultural risks had some school difficulties. Similar results were collected from various cross-sectional studies in the recent literature.


CONCLUSIONS
While 20% of the children had moderate to severe disabilities, an increasing number of minor deficiencies appeared with age. Socio-economic/cultural factors had a deleterious effect even in structurally normal children, but they had an even worse effect in children with minor deficiencies, owing largely to the frequent lack of proper management at home.
Monset-Couchard
M
M
Neonatal Intensive Care Unit, Cochin Port Royal Hospital, René Descartes Paris V University, France.
de Bethmann
O
O
Kastler
B
B
D001927:Brain Diseases / Q000453:epidemiology; D002547:Cerebral Palsy / Q000453:epidemiology; D002653:Child Behavior Disorders / Q000150:complications; D004392:Dwarfism / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006311:Hearing Disorders / Q000150:complications; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008607:Intellectual Disability / Q000453:epidemiology; D007806:Language Disorders / Q000150:complications; D008297:Male; D009048:Motor Skills; D014786:Vision Disorders / Q000150:complications