A Quantitative Review of Mortality and Developmental Disability in Extremely Premature Newborns

ArticleinArchives of Pediatrics and Adolescent Medicine 152(5):425-35 · June 1998with10 Reads
Impact Factor: 5.73 · DOI: 10.1001/archpedi.152.5.425 · Source: PubMed
Abstract

To summarize the literature on mortality rates and prevalences of major neurodevelopmental disabilities and to examine trends of these outcomes over time in extremely premature neonates. MEDLINE was used to search the English literature for studies published since 1970 reporting on both mortality and disability in infants born at or before 26 weeks' gestation (extremely immature [EI] cohort), with a birth weight of 800 g or less (extremely small [ES] cohort), or subgroups of these. Studies were included in the analysis if all of the following were reported: mortality; direct examination of 75% or more of the survivors; and the proportion of patients with at least 1 of the following disabilities: cerebral palsy, mental retardation, blindness, and deafness. Studies reporting cohorts included as a subset of cohorts in another study were excluded. Forty-two studies providing mortality and disability data for 20 cohorts of 4116 EI infants and 38 cohorts of 4345 ES infants born after 1972 met the inclusion criteria. Data were abstracted from all studies that met these criteria by two of us (J.M.L. and D.E.W.), independently; the data were then cross-checked to ensure accuracy. Survival averaged 41% for EI infants and 30% for ES infants, and it increased significantly with time. In contrast to mortality, the prevalences of major neurodevelopmental disabilities among survivors have not changed over time. The most common major disability was mental retardation, found in 14% of EI and ES survivors. Cerebral palsy was found in 12% of EI survivors and 8% of ES survivors, blindness was found in 8% of EI and ES survivors, and deafness was found in 3% of EI and ES survivors. Overall, 22% of EI survivors and 24% of ES survivors were classified as having at least 1 major disability. Each 100 EI or ES livebirths yielded 7 children with major disabilities; this prevalence was correlated with survival across cohorts. The prevalence of disabilities had not changed among EI or ES survivors with increasing survival. However, increasing survival of these infants has resulted in a steadily increasing prevalence of children with disabilities.

    • "However, preterm infants remain at high risk for neurological and developmental consequences that persist into childhood. Although cognitive, language, and behavioral problems may result, poor motor development is also common after preterm birth (Doyle, 1995; Lorenz, Wooliever, Jetton, & Paneth, 1998; Salt & Redshaw, 2006). Postural control, the underlying foundation for motor development (Deborab, 2001), is defined as an infant's ability to maintain the center of his or her body mass or body part over a stable or moving base of support (Massion, 1998; Shumway-Cook & Woollacott, 1995 ). "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: To investigate changes in head lag across postmenstrual age and define associations between head lag and (1) perinatal exposures and (2) neurodevelopment. Method: Sixty-four infants born ≤30 wk gestation had head lag assessed before and at term-equivalent age. Neurobehavior was assessed at term age. At 2 yr, neurodevelopmental testing was conducted. Results: Head lag decreased with advancing postmenstrual age, but 58% (n = 37) of infants continued to demonstrate head lag at term. Head lag was associated with longer stay in the neonatal intensive care unit (p = .009), inotrope use (p = .04), sepsis (p = .02), longer endotracheal intubation (p = .01), and cerebral injury (p = .006). Head lag was related to alterations in early neurobehavior (p < .03), but no associations with neurodevelopment were found at 2 yr. Conclusion: Head lag was related to medical factors and early neurobehavior, but it may not be a good predictor of outcome when used in isolation.
    Full-text · Article · Dec 2015 · The American journal of occupational therapy.: official publication of the American Occupational Therapy Association
    0Comments 0Citations
    • "Preterm birth is also associated with significant mortality and short and long term morbidity for the child, with increased prematurity leading to a greater health risk (Clark, Woodward, Horwood, & Moor, 2008; Greco et al., 2005; Laws & Hilder, 2008). Medical concerns can include lung dysfunction, chronic respiratory disease, seizure disorders, cerebral palsy (McCormick, McCarton, Tonascia, & Brooks-Gunn, 1993), deafness and blindness (Lorenz, Wooliever, Jetton, & Paneth, 1998). The medical condition of the infant can lead to the absence of close physical contact between the mother and the infant (Amankwaa, Pickler, & Boonmee, 2007). "
    [Show abstract] [Hide abstract] ABSTRACT: Aim To systematically review the efficacy of parenting interventions in improving the quality of the relationship between mothers and preterm infants. Method Randomized or quasi-randomized controlled trials (RCT) of parenting interventions for mothers of preterm infants where mother–infant relationship quality outcomes were reported. Databases searched: The Cochrane Library, PubMed, CINAHL, PsycINFO and Web of Science. Results Seventeen studies met the inclusion criteria, 14 with strong methodological quality. Eight parenting interventions were found to improve the quality of the mother–preterm infant relationship. Conclusions Heterogeneity of the interventions calls for an integrated new parenting program focusing on cue-based, responsive care from the mother to her preterm infant to improve the quality of the relationship for these mother–preterm infant dyads.
    Full-text · Article · May 2014 · Infant behavior & development
    0Comments 4Citations
    • "Over three-fifths of the 2.3 million child deaths in India in 2005 were caused by seven conditions: pneumonia, diarrheal diseases, neonatal infections, birth asphyxia, birth trauma, prematurity, and low birth weight (LBW) [1]. LBW remains the leading cause of morbidity and mortality among newborns despite the advances in obstetrical prevention, diagnostics, and therapy [2]. The World Health Organization (WHO 2005) defined LBW as a birth weight of less than 2,500 g [3]. "
    [Show abstract] [Hide abstract] ABSTRACT: Low birth weight (LBW) is one of the major public health problems in India. Hence, there is a need to identify risk factors that, when modified, will reduce the burden of unhealthy children on the healthcare system. The objective of this study was to determine whether periodontitis among mothers in the rural population of India is a risk factor for LBW babies. A hospital-based case control study was conducted among 340 postpartum mothers. The cases consisted of 170 women who had given birth to babies weighing <2,500 g, while the control group consisted of 170 women who had given birth to babies weighing ≥2,500 g. Details of the mothers were taken from the hospital records and through a personal interview, and a full-mouth periodontal examination was performed postpartum, which included probing depth, clinical attachment level, and bleeding on probing on six sites per tooth. LBW cases had a significantly worse periodontal status than the controls, having an odds ratio (OR) of 2.94 (P=0.01). The multivariate logistic regression model demonstrated that periodontal disease is a significant independent risk factor with an adjusted odds ratio (aOR) of 2.85 for the LBW group (95% confidence interval [CI], 1.62-5.5). Other factors showing significant associations with LBW were pre-eclampsia (aOR, 4.49; 95% CI, 1.4-14.7), preterm labor (aOR, 5.5; 95% CI, 3.2-9.9), and vaginal type of delivery (aOR, 2.74; 95% CI, 1.4-5.2). Periodontitis represents a strong, independent, and clinically significant risk factor for LBW. Periodontal therapy should form a part of the antenatal preventive care among rural women in India.
    Full-text · Article · Apr 2014 · Journal of periodontal & implant science
    0Comments 7Citations
Show more