[Neurological follow-up of very low birth weight newborns at the age of two years (1998-1999)]

[SEN1500: design and implementation of a registry of infants weighing less than 1,500 g at birth in Spain]

OBJECTIVE

To design and implement a registry of infants weighing less than 1,500 g at birth in Spain.

MATERIAL AND METHODS

Prospective, cohort, multicenter study. All live born infants weighing less than 1,500 g in several voluntarily participating neonatal units in public and private hospitals were included.

RESULTS

In the first 4 years of the registry (2002 to 2005), 9,638 very-low-birth-weight infants were born in the 65 neonatal units that have so far joined the program.

CONCLUSIONS

The goal of very-low-birth-weight infant databases is to try to improve the quality and safety of the medical care given to these newborns and their families. This type of program helps to coordinate and promote several areas, including those of health education, training of medical staff, research and development, surveillance and quality improvement.

Morbilidad a los dos años de edad en niños con un peso al nacimiento menor de 1.500 g

OBJECTIVES

To determine morbidity at 2 years' corrected age in a cohort of neonates with a birth weight of less than 1,500 g born in 1999-2000 in a tertiary hospital in the Autonomous Community of Madrid.

PATIENTS AND METHODS

An observational longitudinal follow-up study was performed in a cohort of 213 infants with a birth weight of < 1,500 g. Of these, 188 (87%) completed the 2-year follow-up. Various types of neurosensorial disability were studied, paying special attention to the main impairments: vision, hearing and motor impairment, and low development quotient.

RESULTS

Among the patients initially included in the study, 87% completed the follow-up; 17.1% had one or more major sequela. We found one case (0.4%) of bilateral neurosensorial deafness and one case of bilateral blindness. At the age of 2 years, 5.8 % (11/188) had cerebral palsy, 14.9% had a development quotient below 85 and 18% had not reached the 3rd percentile for weight. Factors of poor neurological prognosis were subnormal head size at the age of 2 years and white matter disease (including persistent intraparenchymal periventricular echodensity and ventriculomegaly or irregular shape) as ultrasound findings.

CONCLUSIONS

Less than a fifth of the very low birth weight infants presented severe sequelae at 2 years of follow-up. Factors of poor neurological prognosis were subnormal head size at 2 years and the presence of white matter disease on ultrasonography. The findings on growth and development were worrying, since 18 % of the patients had not reached the 3rd percentile for weight at 2 years' corrected age.

Crecimiento posnatal hasta los dos años de edad corregida de una cohorte de recién nacidos de muy bajo peso de nacimiento

OBJECTIVE

To study postnatal somatic growth up to 2 years of corrected postnatal age (CPA) in a cohort of very low birth weight infants (VLBWI) in our unit, according to their intrauterine growth status at birth.

PATIENTS AND METHODS

We performed an observational follow-up study of postnatal growth in a cohort of VLBWI (birth weight < 1,500 g) attended from January 1, 1994 to December 31, 1999. Weight, length, and head circumference were assessed at birth and again at 2 years CPA. Infants were classified as small-for-gestational age (SGA) if weight was below 2 standard deviations (SD) of the reference population mean.

RESULTS

The cohort consisted of 260 VLBWI (18.5% SGA). Mean gestational age (SD) was 29 (2.7) weeks, weight was 1,150 (223) g, length was 37.4 (2.7) cm, and head circumference was 27 (1.8) cm. At birth Z-scores were -0.82, -0.92 and -0.8 for weight, length and head circumference. The corresponding mean Z scores at 2 years' CPA were -1.44, -1.49 and -0.31. At 2 years' CPA, more SGA infants still had a weight below the 3rd percentile than those with normal birthweight (26% vs. 16%). SGA infants had a higher daily weight increase during their hospital stay (27.5 vs. 21.2 g/day, p > 0.5). Gender did not significantly influence the growth pattern.

CONCLUSIONS

Weight showed the lowest postnatal increase, particularly in infants < 1,000 g. Head circumference showed the greatest catch-up growth pattern, almost reaching the mean for the general population by 2 years' CPA. Growth retardation in SGA continued up to 2 years' CPA.

Reducing length of stay in hospital for very low birthweight infants by involving mothers in a stepdown unit: an experience from Karachi (Pakistan)

PROBLEM

Clinical care of infants with a very low birth weight (less than 1500 g) in developing countries can be labour intensive and is often associated with a prolonged stay in hospital. The Aga Khan University Medical Center in Karachi, Pakistan, established a neonatal intensive care unit in 1987. By 1993-4, very low birthweight infants remained in hospital for 18-21 days.

STRATEGIES FOR CHANGE

A stepdown unit was established in September 1994, with mothers providing all basic nursing care for their infants before being discharged under supervision.

KEY MEASURES FOR IMPROVEMENT

We analysed neonatal outcomes for the time periods before and after the stepdown unit was created (1987-94 and 1995-2001). We compared these two time periods for survival after birth until discharge, morbidity patterns during hospitalisation, length of stay in hospital, and readmission rates to hospital in the four weeks after discharge.

EFFECTS OF CHANGE

Of 509 consecutive, very low birthweight infants, 494 (97%) preterm and 140 (28%) weighing < 1000 g at birth), 391 (76%) survived to discharge from the hospital. The length of hospitalisation fell significantly from 1987-90, when it was 34 (SD 18) days, to 16 (SD 14) days in 1999-2001 (P < 0.001). Readmission rates to hospital did not rise, nor did adverse outcomes at 12 months of age.

LESSONS LEARNT

Our results indicate that it is possible to involve mothers in the active care of their very low birthweight infants before discharge. This may translate into earlier discharge from hospital to home settings without any increase in short term complications and readmissions.