Arch Dis Child Fetal Neonatal Ed 2001;85:F159-F164 ( November )

Outcome at 14 years of extremely low birthweight infants: a regional study

L W Doyle^a, D Casalaz^b, for the Victorian Infant Collaborative Study Group

^a The Royal Women's Hospital, Melbourne, Australia, ^b The Mercy Hospital for Women, Melbourne

Correspondence to: Associate Professor Doyle, Department of Obstetrics and Gynaecology, The Royal Women's Hospital, 132 Grattan St, Carlton, Australia 3053. lwd{at}unimelb.edu.au

Accepted 8 June 2001

OBJECTIVESTo determine the neurosensory outcome at 14 years of age of a regional cohort of extremely low birthweight (ELBW) children, to contrast their prognosis with normal birthweight (NBW) controls, and to determine the predictive value of assessments earlier in childhood.
DESIGNGeographically determined cohort study.
SETTINGThe state of Victoria, Australia.
PATIENTSConsecutive ELBW survivors of birth weight 500-999 g (n = 88) born during 1979-1980, and 60 randomly selected contemporaneous NBW (birth weight > 2499 g) controls.
MAIN OUTCOME MEASURESRates of neurosensory impairments and disabilities at 14 years of age, and earlier in childhood.
RESULTSOf 351 ELBW consecutive live births, 88 (25%) survived and 79 (90%) of the survivors were assessed at 14 years of age. Of the 79 ELBW children assessed, eight (10%) had cerebral palsy, five (6%) had bilateral blindness, four (5%) were deaf requiring hearing aids, and 36 (46%) had an intelligence quotient (IQ) < 1 SD compared with the mean for the NBW controls. Overall 11 (14%) ELBW children were severely disabled, 12 (15%) were moderately disabled, 20 (25%) were mildly disabled, and 36 (46%) had no disability. In contrast, only one (2%) of 42 NBW children assessed had a severe disability, six (14%) had a mild disability, and the remaining 35 (83%) were not disabled. Comparing psychological test scores for ELBW children with those for NBW controls, rather than test norms, avoided bias in the assessment of disability earlier in childhood. Relative to assessments earlier in childhood, the prediction of disability at 14 years of age was highly significant at each of 2, 5, and 8 years of age, but the accuracy progressively increased with age.
CONCLUSIONSELBW children have substantially higher rates of neurosensory impairments and disabilities at 14 years of age than NBW controls. Comparison of ELBW children with NBW controls avoids bias in the assessment of disability. Early childhood assessments are highly predictive of disability at 14 years of age.


Keywords: impairment; disability; cerebral palsy; low birth weight

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© 2001 by Archives of Disease in Childhood
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