Outcome for infants of very low birthweight: survey of world literature

Abstract

Reports from developed countries world wide describing the outcome for infants of very low birthweight (VLBW, less than or equal to 1500 g) born since 1946 show that, in general, mortality rates and the prevalence of major handicap in survivors were high until 1960. Since then the chances of healthy survival have trebled, whereas the handicap-rate has remained stable and relatively low at 6--8% of VLBW live births.

PIP: 22 reports on very low birthweight infants (VLBW; 1500 g) were reviewed to see if inferences can be drawn about trends in healthy survival, mortality rate, and handicap rate in VLBW infants born in countries with modern medical services. Data from the studies were pooled according to the quinquennium of birth and subjected to statistical tests and analysis. In the 1940's and 1950's, very few VLBW infants survived because of inadequate treatment and knowledge of neonatal diseases (phase 1 of perinatal care). In the late 50's and 60's, knowledge concerning the normal physiology of VLBW infants and derangement which cause death and damage in newborns increased. Treatments were developed and mortality rate started declining but sometimes at the expense of increased prevalaence of handicap among the survivors (phase 2). From the early 1960's onward, chances of healthy survival of VLBW infants increased, and prevalence of handicap remained stable and relatively low, 6 to 8% of total VLBW births (phase 3). Care of VLBW infants is probably entering phase 4 of perinatal care. Use of computerized tomography and real-time ultrasound enable diagnosis of derangements and lesions which contribute to neonatal deaths. It is hoped that social and obstetric measures will contribute to a decline in the number of VLBW requiring intensive care.