Published online May 1, 2007
PEDIATRICS
Vol. 119
No. 5
May 2007, pp.
1044
(doi:10.1542/peds.2007-0569)
Improved Outcomes of Extremely Low Birth Weight Infants
Margot Ahronovich, MD
Ida Sue Baron, PhD
Fern Litman, MD
Department of Neonatology
Inova Fairfax Hospital for Children
Falls Church, VA 22042
To the Editor.—
It was with much interest that we read the article by Wilson-Costello et al1 that reported the improved neurodevelopmental outcomes for extremely low birth weight (ELBW) infants born in 2000–2002. This cohort included nearly 1500 children overall, with 233 children born in 2000–2002. More than 92% of the surviving children born in 2000–2002 were tested at follow-up. Results of this large study revealed a relatively stable survival rate from 1990–1999 compared with 2000–2002 (68% vs 71%, respectively) and a significant decrease in neurodevelopmental impairment from 35% in the 1990s to 23% in 2000–2002. The rate of cerebral palsy decreased from 13% in the 1990s to a 5% rate in 2000–2002. These findings were attributed to a variety of factors including increased antenatal steroid use and cesarean-section delivery as well as decreased sepsis, severe cranial ultrasound abnormalities, and postnatal steroid use.
Although our sample size is smaller and spans the years 1998–2000, we too have found encouraging neurodevelopmental outcomes for ELBW infants at 6 years of age.2 We report a survival rate of 80% to 85% for the years 1998–2000. Our ELBW cohort had average function across a wide range of standardized cognitive, neuropsychological, and behavioral tests, with no subjects falling out of the reference range for any test administered. Standardized tests of general intelligence, academic achievement, executive function, attention, language, memory, motor function, and behavior were administered. Infants born at 23 to 25 weeks' gestation had no significant differences in outcome compared with those born at 26 to 28 weeks' gestation.3 It is interesting to note that our cohort had a 75% incidence of sepsis during their neonatal course, and 100% received postnatal dexamethasone therapy for chronic lung disease. None of our subjects had greater than a grade II intraventricular hemorrhage. Our data support the findings of improved neurodevelopmental outcome for ELBW infants, although we cannot attribute these findings to lack of dexamethasone use postnatally or to a decreased sepsis incidence. Our data suggest that in the absence of significant intracerebral complications, at least average early school age outcomes are likely regardless of gestational age, birth weight, and use of postnatal steroids. In addition, these infants can be expected to have average neurodevelopmental outcome regardless of common medical complications during the newborn period and that birth before 26 weeks' gestational age does not portend intellectual, neuropsychological, or behavioral deficit.
REFERENCES
- Wilson-Costello D, Friedman H, Minich N, et al. Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000–2002.
Pediatrics. 2007;119
:37
–45[Abstract/Free Full Text]
- Ahronovich M, Litman F, Baron I, Gidley Larson J, Beck R. Neurocognitive development and motor outcome of extremely low birth weight children at age six [abstract].
J Perinatol. 2006;26
:583
–584
- Baron I, Ahronovich M, Litman F, Erickson K. Neuropsychological outcome of extremely low birthweight children born at 23 to 25 weeks gestational age: intact function at early school age [abstract].
J Int Neuropsychol Soc. 2007; In press
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
