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Department of Child Health,
University of Liverpool
Regional Neonatal Intensive Care Unit,
Liverpool Women's Hospital,
Crown Street, Liverpool
L8 7SS
Correspondence to: Dr R W I Cooke.
Accepted 16 October 1998
AIM
To evaluate the
effects of changing perinatal practice on outcome in terms of cranial
ultrasound appearances and subsequent cerebral palsy rates in survivors.
METHODSA tertiary
neonatal centre based prospective cohort study was undertaken of very
low birthweight infants, in three 4 year periods: 1982-5, 1986-9,
1990-3. Rates of survival, parenchymal cerebral haemorrhage (PH), and
leucomalacia on cerebral ultrasound scans, and cerebral palsy (CP) at
the age of 3 years were compared. Antenatal steroid prophylaxis and
postnatal surfactant use were also compared.
RESULTSVLBW infants
(1722) were admitted over the 12 years, of whom 1268 (73.6%) were
discharged home. Neonatal survival increased significantly over the
three periods (69.2%, 72.9%, 79.7%; p<0.0001). PH declined from
14.9% to 10.5% (p=0.032) after 1990 as did CP rate (10.9% to 7.3%;
p=0.046). The use of antenatal steroids and postnatal surfactant
greatly increased during this period. Steroid use was significantly
associated with increased survival (OR 3.34, 2.31-4.79), decreased PH
(OR 0.44, 0.28-0.71), and decreased risk of CP in survivors (OR 0.47, 0.27-0.81) after standardising for gestation, birthweight, sex, place
and mode of delivery. Similar effects for surfactant did not remain
significant after steroid use had been accounted for.
CONCLUSIONImproved
survival in VLBW infants since 1990 has been accompanied by a fall in
PH and subsequent CP rates in survivors. This change is most likely to
be due to the greater use of antenatal steroid prophylaxis.
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