title: Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000-2002.
abstract: BACKGROUND
  Neurodevelopmental impairment of extremely low birth weight infants increased in the 1990s. Modern therapeutic changes may have influenced more recent neonatal outcomes.
  
  
  OBJECTIVE
  We sought to compare neonatal therapies and outcomes among all extremely low birth weight infants born in 2000-2002 (period III) to 2 previous periods: 1982-1989 (period I) and 1990-1999 (period II).
  
  
  METHODS
  The population included 496 extremely low birth weight infants born at our perinatal center during period I, 749 during period II, and 233 during period III. Therapies, rates of death, and survival with and without impairment at 20 months' corrected age were compared.
  
  
  RESULTS
  Between periods I and II, survival increased from 49% to 68% as did neonatal morbidity. This resulted in increased survival without impairment but also increased survival with impairment. Changes in therapy during period III included an increase in antenatal steroid use and a decrease in postnatal steroid use, although the rate of chronic lung disease did not change. Sepsis decreased, as did severe intraventricular hemorrhage. On follow-up, the rate of cerebral palsy decreased from 13% to 5%, resulting in a decrease in neurodevelopmental impairment from 35% to 23%. As a result, during period III versus II, survival without impairment increased, whereas survival with impairment decreased.
  
  
  CONCLUSIONS
  Since 2000, neurodevelopmental impairment has decreased among extremely low birth weight infants. A variety of perinatal and neonatal factors were associated with the improved outcomes including increased antenatal steroid use and cesarean section delivery, as well as decreased sepsis, severe cranial ultrasound abnormalities, and postnatal steroid use despite no change in the rate of chronic lung disease.
authors.affiliation: Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA. drfjcmd@aol.com
authors.forename: Deanne
authors.initials: D
authors.lastname: Wilson-Costello
authors.forename: Harriet
authors.initials: H
authors.lastname: Friedman
authors.forename: Nori
authors.initials: N
authors.lastname: Minich
authors.forename: Bonnie
authors.initials: B
authors.lastname: Siner
authors.forename: Gerry
authors.initials: G
authors.lastname: Taylor
authors.forename: Mark
authors.initials: M
authors.lastname: Schluchter
authors.forename: Maureen
authors.initials: M
authors.lastname: Hack
mesh_terms: D002547:Cerebral Palsy / Q000453:epidemiology / Q000209:etiology; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007226:Infant Mortality; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000628:therapy; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology