Premature Infant Outcomes.ppt

Premature Infant Outcomes Linda Wallen, MD Prevalence of Cerebral Palsy VLBW Infants - 1982-1994 Survival Outcome of Infants Weighing 800 g 1979 to 1994 Outcomes of ELBW infants Historical reasons for reliance on neurologic morbidities Public misperception of prevalence of severe disability Limitation of range of outcomes studied Other health outcomes that are affected Increased incidence of asthma Increased visual perceptual expressive language disabilities Increased behavioral problems Growth failure Family and child perception of health and outcome Psychological outcomes Other factors which influence outcome = risk factors and post discharge environment, heavily influenced by maternal education, income level, smoking, poor maternal health (physical or mental) Mortality Cerebral Palsy (% live births) (% survivors) 1982-1984 36.8 9.1 1984-1986 31.5 12.3 1986-1988 36.1 11.9 1988-1990 29.2 9.2 1990-1992 21.8 3.6 1992-1994 13.8 6.6 (O’Shea et al., 1998) (O’Shea et al., Pediatrics 100: 982-986, 1997) Survival Outcome of Infants, 401-1250 g 1994 to 1996 (Finer et al., Pediatrics 104: 428-434, 1999) Survival Outcome of Infants, 1250 g Doernbecher NCC, 1995 to 1998 Bayley Scales at 30 Months for Infants Born at 26 Weeks Gestation (EPIcure Group (UK) follow up Mar-Dec 1995. New England J Med 343:381, 2000) Individual Scores on Bayley Scales at 30 months by Gestational Age From NICHD Network 1993-1994 Follow-Up. Pediatrics. 105:1221-22, 2000. Adj. Risk for No Independent Walking Adj. Risk for No Independent Feeding Risk Factors for Cerebral Palsy in Infants 1000 g at 18-22 Months From NICHD Network 1993-1994 Follow-Up. Pediatrics. 105:1220-21, 2000. Adjusted Risk Factors for MDI 70 Adjusted Risk Factors for PDI 70 Risk Factors for Severe Developmental Delay in Infants 1000 g at 18-22 Months Died (2%) No disability (49%) No data (1%) Other disability (25%) Severe disability (25%) (EPIcure Group (UK) follow up Mar-Dec 1995. New England