229
Early Human Development, 30 (1992) 229-239 Elsevier Scientific Publishers Ireland Ltd.
EHD 01336
Improving health status in extremely low birthweight children between two and five years V.Y.H. Yu, M.L. Manlapaz, J. Tobin, E.A. Carse, M.P. Charlton and J.R. Gore Department
of Paediatrics.
Monash Medical Centre, Melbourne,
Victoria (Australia)
(Received 16 March 1992; revision received 13 July 1992; accepted 16 July 1992)
Summary
The 5-year outcome of 101 extremely low birthweight (ELBW, < 1000 g) children discharged from the Neonatal Intensive Care Unit was reported. Over this period, there were four post-discharge deaths. The neurodevelopmental impairment rate was 18% overall: cerebral palsy 7%, blindness 3%, deafness 3% and developmental delay 10%. Seventy-one percent of children were readmitted to hospital. The mean number of admissions was 2.4 per child and the mean duration of total hospital stay was 11.3 days per child in the 5-year period. A trend was observed in a reduction in the readmission rate and hospital days in the 2-5-year period compared to the period between discharge and 2 years, though the differences were not statistically significant. The most common reason for readmission was for surgical procedures, primarily aural ventilation tube insertion and tonsillectomy and adenoidectomy. Significant health problems included recurrent wheezing episodes, stridor and croup in the period up to 2 years and otitis media and tonsillitis between 2 and 5 years. There was some catch-up growth, especially in height, between 2 and 5 years. Children with < 800 g birthweight had similar rates of neurodevelopmental impairment and hospital readmission to those of 800-999 g birthweight. However, they experienced more otitis media and pneumonia, had more ear, nose and throat operations, and at 5 years of age, more were below the 3rd centile for weight. This study showed that the health status of ELBW children had improved between 2 and 5 years, but they continued to experience recurrent health problems and hospital readmissions which would have resulted in added financial and emotional burdens to their families. Key work
extremely low birthweight infants; growth and development; morbidity
Correspondence to: V.Y.H. Yu, Department of Paediatrics, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
0378-3782/92/$05.00 0 1992 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
230
Introduction
Although extremely low birthweight (ELBW, < 1000 g) births have a low prevalence in Victoria (0.28% of livebirths) [6], they may consume considerable health care resources as an earlier report from our unit found that they contributed a disproportionate 29% of the neonatal intensive care workload [53]. Nevertheless, a recent population-based study from Victoria is encouraging in that it documented an improved survival rate of ELBW infants with a concomitant reduction in their late disability rate [51]. It has been reported that medical care costs of high-risk graduates from neonatal intensive care units (NICUs) in the first 1-3 years were substantially higher than that of a normal child [27,42]. We have previously reported a high prevalence of hospital readmissions and continued health concerns in ELBW children in the first 2 years [3]. Because medical opinions vary concerning treatment for infants below 800 g, our earlier study also compared the outcome of survivors born at < 800 g with those born at 800-999 g. It showed that up to the age of 2 years, the former group compared with the latter group did not have a significantly higher rate of neurodevelopmental impairment, health problems, readmission to hospital, suboptimal growth or behavioural disorders, except for otitis media [3]. Concerns remain regarding the longer term outcome of those born at < 800 g birthweight, even though the survival rate of this group has improved [4,12,16,17,19]. Indeed, not much is known concerning the health problems in ELBW survivors beyond 2 years of age, since there are only a small number of such reports [2,26,34,36,37]. As we only began to review 5-year outcome of our ELBW survivors beginning from those born in 1979, it was not possible for us to report on subsequent health problems from exactly the same cohort as in our earlier study on 2-year outcome [3]. Therefore, based on a relatively more recent cohort of ELBW infants, the aims of this study were to report on their long-term survival, to document any differences in impairment rates at 5 years of age between survivors of
Early Human Development, 30 (1992) 229-239 Elsevier Scientific Publishers Ireland Ltd.
EHD 01336
Improving health status in extremely low birthweight children between two and five years V.Y.H. Yu, M.L. Manlapaz, J. Tobin, E.A. Carse, M.P. Charlton and J.R. Gore Department
of Paediatrics.
Monash Medical Centre, Melbourne,
Victoria (Australia)
(Received 16 March 1992; revision received 13 July 1992; accepted 16 July 1992)
Summary
The 5-year outcome of 101 extremely low birthweight (ELBW, < 1000 g) children discharged from the Neonatal Intensive Care Unit was reported. Over this period, there were four post-discharge deaths. The neurodevelopmental impairment rate was 18% overall: cerebral palsy 7%, blindness 3%, deafness 3% and developmental delay 10%. Seventy-one percent of children were readmitted to hospital. The mean number of admissions was 2.4 per child and the mean duration of total hospital stay was 11.3 days per child in the 5-year period. A trend was observed in a reduction in the readmission rate and hospital days in the 2-5-year period compared to the period between discharge and 2 years, though the differences were not statistically significant. The most common reason for readmission was for surgical procedures, primarily aural ventilation tube insertion and tonsillectomy and adenoidectomy. Significant health problems included recurrent wheezing episodes, stridor and croup in the period up to 2 years and otitis media and tonsillitis between 2 and 5 years. There was some catch-up growth, especially in height, between 2 and 5 years. Children with < 800 g birthweight had similar rates of neurodevelopmental impairment and hospital readmission to those of 800-999 g birthweight. However, they experienced more otitis media and pneumonia, had more ear, nose and throat operations, and at 5 years of age, more were below the 3rd centile for weight. This study showed that the health status of ELBW children had improved between 2 and 5 years, but they continued to experience recurrent health problems and hospital readmissions which would have resulted in added financial and emotional burdens to their families. Key work
extremely low birthweight infants; growth and development; morbidity
Correspondence to: V.Y.H. Yu, Department of Paediatrics, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
0378-3782/92/$05.00 0 1992 Elsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
230
Introduction
Although extremely low birthweight (ELBW, < 1000 g) births have a low prevalence in Victoria (0.28% of livebirths) [6], they may consume considerable health care resources as an earlier report from our unit found that they contributed a disproportionate 29% of the neonatal intensive care workload [53]. Nevertheless, a recent population-based study from Victoria is encouraging in that it documented an improved survival rate of ELBW infants with a concomitant reduction in their late disability rate [51]. It has been reported that medical care costs of high-risk graduates from neonatal intensive care units (NICUs) in the first 1-3 years were substantially higher than that of a normal child [27,42]. We have previously reported a high prevalence of hospital readmissions and continued health concerns in ELBW children in the first 2 years [3]. Because medical opinions vary concerning treatment for infants below 800 g, our earlier study also compared the outcome of survivors born at < 800 g with those born at 800-999 g. It showed that up to the age of 2 years, the former group compared with the latter group did not have a significantly higher rate of neurodevelopmental impairment, health problems, readmission to hospital, suboptimal growth or behavioural disorders, except for otitis media [3]. Concerns remain regarding the longer term outcome of those born at < 800 g birthweight, even though the survival rate of this group has improved [4,12,16,17,19]. Indeed, not much is known concerning the health problems in ELBW survivors beyond 2 years of age, since there are only a small number of such reports [2,26,34,36,37]. As we only began to review 5-year outcome of our ELBW survivors beginning from those born in 1979, it was not possible for us to report on subsequent health problems from exactly the same cohort as in our earlier study on 2-year outcome [3]. Therefore, based on a relatively more recent cohort of ELBW infants, the aims of this study were to report on their long-term survival, to document any differences in impairment rates at 5 years of age between survivors of
