Survival and subsequent outcome to five years of age for infants with birth weights less than 801 grams born from 1983 to 1989.
OBJECTIVE
To determine the neurodevelopmental status for 5-year-old survivors with birth weights (BW) <801 gm born in the 1980s and to assess differences in outcome for those born from 1986 to 1989 compared with those born from 1983 to 1985.


METHODS
This investigation was a longitudinal follow-up of all infants with BW from 450 to 800 gm born at one of two hospitals in Kansas City, Mo., between January 1983 and December 1989. Medical records were reviewed at discharge to determine obstetric and neonatal interventions and complications. Neurodevelopmental outcome was assessed by a multidisciplinary evaluation at 60 +/- 3 months old. Multiple logistic regression analyses were used to determine factors statistically associated with survival and long-term outcome.


RESULTS
The percentage of infants surviving to hospital discharge was not different between periods. From 1986 to 1989, there were more infants with BW <601 gm and <26 weeks' gestational age. Survival was greater for gestational age categories > or = 24 weeks. BW, gestational age, female gender (p < 0.0001), and birth era (p < 0.01) were each independently significantly associated with improved survival. At 5 years of age, there were no significant outcome differences between birth era cohorts. Overall, approximately 21% of infants had severe disabilities. Long-term outcome was significantly influenced by the occurrence of intracranial hemorrhage and socioeconomic status.


CONCLUSIONS
For infants with BW <801 gm, survival of infants > or = 24 weeks' gestational age was greater in 1986 to 1989 compared with 1983 to 1985, although the 5-year neurodevelopmental outcome was not different between groups. The significant impact of social risk status on outcome suggests that factors outside the intensive care nursery must be addressed to improve long-term outcome.
Kilbride
H W
HW
Department of Pediatrics, The Children's Mercy Hospital, University of Missouri-Kansas City, 64108, USA.
Daily
D K
DK
D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000401:mortality*; D002423:Cause of Death; D002675:Child, Preschool; D019988:Children with Disabilities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000401:mortality*; D007236:Infant, Small for Gestational Age; D008297:Male; D008489:Medical Indigency; D009460:Neurologic Examination; D010348:Patient Care Team; D011610:Psychosocial Deprivation; D012307:Risk Factors; D015996:Survival Rate