%0 Journal Article %1 Kitchen1992 %A Kitchen, W. H. %A Rickards, A. L. %A Doyle, L. W. %A Ford, G. W. %A Kelly, E. A. %A Callanan, C. %D 1992 %J Med J Aust %K Cerebral Palsy; Child; Child Development; Cohort Studies; Deafness; Disabled Persons; Follow-Up Hospitals, Maternity; Humans; Infant Mortality; Infant, Low Birth Weight; Newborn; Intensive Care, Neonatal; Mental Retardation; Prospective Respiration, Artificial; Survival Rate; Treatment Outcome; Victoria %N 3 %P 154--158 %T Improvement in outcome for very low birthweight children: apparent or real? %V 157 %X OBJECTIVE: To determine whether improvement in the survival rate of infants with a birthweight of less than 1501 g was accompanied by an increase in the rate of neurological impairment or disability among the survivors. DESIGN, SETTING AND PATIENTS: Two cohorts of consecutive very low birthweight infants (birthweight less than 1501 g) in one tertiary perinatal centre were followed prospectively to eight years of age; for both cohorts, comparison groups of children of birthweight more than 1501 g were randomly selected from hospital births. INTERVENTIONS: The first cohort was born before the introduction of assisted ventilation (1966-1970), the second after assisted ventilation was well established (1980-1982). MAIN OUTCOME MEASURES: Comparisons between cohorts, at eight years of age, of the survival rates and the rates of severe sensorineural impairments and disabilities. RESULTS: The survival rate for very low birthweight infants to eight years of age almost doubled between these cohorts, from 37.1\% to 67.8\% (odds ratio OR, 3.4; 95\% confidence interval CI, 2.5-4.7; chi 2 = 57.6; P much less than 0.0001). The biggest gain was the increase in non-disabled survivors at eight years of age, from 52.6\% in the first cohort to 80.8\% in the second cohort (OR, 3.5; 95\% CI, 2.2-5.7; chi 2 = 26.7; P less than 0.0001). Furthermore, the rate of severe disabilities in survivors fell substantially, from 13.6\% to 4.1\% (OR, 0.31; 95\% CI, 0.14-0.69; chi 2 = 8.3; P less than 0.01). Of specific impairments, the rate of severe sensorineural deafness fell substantially (3.2\% to 0\%: OR, 0.14, 95\% CI, 0.02-0.81; chi 2 = 4.8; P less than 0.05), as did the rate of severe intellectual impairment (13.0\% to 2.7\%: OR, 0.25; 95\% CI, 0.11-0.57; chi 2 = 10.7; P less than 0.002). Only the rate of cerebral palsy increased, but not significantly (2.6\% to 6.8\%; OR, 2.6; 95\% CI, 0.89-7.6; chi 2 = 3.0). CONCLUSIONS: It has been possible to improve the survival rate of very low birthweight infants over time without increasing the number of severely disabled survivors. Whether the long-term outcome for these infants is continuing to improve with more recent advances in perinatal care remains to be determined.

@article{Kitchen1992, abstract = {OBJECTIVE: To determine whether improvement in the survival rate of infants with a birthweight of less than 1501 g was accompanied by an increase in the rate of neurological impairment or disability among the survivors. DESIGN, SETTING AND PATIENTS: Two cohorts of consecutive very low birthweight infants (birthweight less than 1501 g) in one tertiary perinatal centre were followed prospectively to eight years of age; for both cohorts, comparison groups of children of birthweight more than 1501 g were randomly selected from hospital births. INTERVENTIONS: The first cohort was born before the introduction of assisted ventilation (1966-1970), the second after assisted ventilation was well established (1980-1982). MAIN OUTCOME MEASURES: Comparisons between cohorts, at eight years of age, of the survival rates and the rates of severe sensorineural impairments and disabilities. RESULTS: The survival rate for very low birthweight infants to eight years of age almost doubled between these cohorts, from 37.1\% to 67.8\% (odds ratio [OR], 3.4; 95\% confidence interval [CI], 2.5-4.7; chi 2 = 57.6; P much less than 0.0001). The biggest gain was the increase in non-disabled survivors at eight years of age, from 52.6\% in the first cohort to 80.8\% in the second cohort (OR, 3.5; 95\% CI, 2.2-5.7; chi 2 = 26.7; P less than 0.0001). Furthermore, the rate of severe disabilities in survivors fell substantially, from 13.6\% to 4.1\% (OR, 0.31; 95\% CI, 0.14-0.69; chi 2 = 8.3; P less than 0.01). Of specific impairments, the rate of severe sensorineural deafness fell substantially (3.2\% to 0\%: OR, 0.14, 95\% CI, 0.02-0.81; chi 2 = 4.8; P less than 0.05), as did the rate of severe intellectual impairment (13.0\% to 2.7\%: OR, 0.25; 95\% CI, 0.11-0.57; chi 2 = 10.7; P less than 0.002). Only the rate of cerebral palsy increased, but not significantly (2.6\% to 6.8\%; OR, 2.6; 95\% CI, 0.89-7.6; chi 2 = 3.0). CONCLUSIONS: It has been possible to improve the survival rate of very low birthweight infants over time without increasing the number of severely disabled survivors. Whether the long-term outcome for these infants is continuing to improve with more recent advances in perinatal care remains to be determined.}, added-at = {2014-07-19T20:38:09.000+0200}, author = {Kitchen, W. H. and Rickards, A. L. and Doyle, L. W. and Ford, G. W. and Kelly, E. A. and Callanan, C.}, biburl = {https://www.bibsonomy.org/bibtex/2054839f9593fb5703c16eb85a0b26989/ar0berts}, groups = {public}, interhash = {97eaf978989142ad64d1435b8b6285ce}, intrahash = {054839f9593fb5703c16eb85a0b26989}, journal = {Med J Aust}, keywords = {Cerebral Palsy; Child; Child Development; Cohort Studies; Deafness; Disabled Persons; Follow-Up Hospitals, Maternity; Humans; Infant Mortality; Infant, Low Birth Weight; Newborn; Intensive Care, Neonatal; Mental Retardation; Prospective Respiration, Artificial; Survival Rate; Treatment Outcome; Victoria}, month = Aug, number = 3, pages = {154--158}, pmid = {1386135}, timestamp = {2014-07-19T20:38:09.000+0200}, title = {Improvement in outcome for very low birthweight children: apparent or real?}, username = {ar0berts}, volume = 157, year = 1992 }