Low birthweight and neurodevelopmental handicap.

There appears to be no doubt that where there is supportive obstetric care and intensive neonatal care, the long-term outlook for the very preterm infant has improved dramatically since the 1950s. However, the rate of neurodevelopmental handicap in these children is still unacceptably high when compared with term infants. To improve their outlook, modifications of obstetric and neonatal care, particularly in relation to the prevention of hypoxic, traumatic and biochemical insults, must continue to be introduced and tested until more fundamental research determines the mechanisms underlying preterm labour, and makes more effective prevention and treatment of preterm labour possible. Those infants who have suffered IUGR, certainly when it has been severe, never achieve their full intellectual potential. It is already recognized that some of the associated problems of IUGR cause handicap. Intrapartum hypoxia/acidosis, neonatal hypothermia, hypoglycaemia, polycythaemia and hyperbilirubinaemia for example, should be identified and appropriate action taken to prevent their effects. Further research is required to determine what duration and character of IUGR alone influences intellectual development before intervention in these pregnancies can be investigated.