[Developmental impairment of children with very low and extremely low birth weight at 24 months corrected age, born in the Czech Republic in 2000-2009].

OBJECTIVE

To evaluate the incidence of neonatal morbidity (NM), and developmental impairments (DIs) of very low (VLBW) and extremely low birth weight (ELBW) infants born in 2000-2009.

DESIGN

Epidemiological study.

SETTING

Outpatient clinics for children with perinatal risk at the regional neonatal centers.

METHODS

Data on live born, specific neonatal mortality (SNM) and NM data were taken from the database the database of Institute of Health Information and Statistics of Czech Republic (IHIS CR). The incidence of DIs (cerebral palsy - CP, developmental delay - DD, growth retardation and sensory impairment) was evaluated at 24 months corrected age. Each cohort included newborn infants born always in the two-year periods.. Comparison of the incidence of DIs according to the birth-weight or to gestational age was performed in children born in 2009.

RESULTS

1. NM - in VLBW newborns, CNS morbidity and early indecisions decreased slightly (i.e. by 7 and 5%), other forms remained unchanged. In ELBW infants, CNS morbidity declined by 13.9% (p<0.05), early infections only by 5% (NS). - 2. DIs: - in VLBW infants, cerebral morbidity and early infections were reduced slightly (i.e. by 7 and 5% resp.). In ELBW category, CP decreased by 12%, and visual impairment by 9% (p<0.05). - 3. The occurrence of DIs by birth weight or gestational age did not differ, only in children <1000 g, in comparison with the group of <28 wks, was delayed growth increased by 6% (NS). - 4. In 2000-2007, SNM rate and also number of disabled children declined continuously. During period 2008-2009, in contrast to the previous 8 years, incidence of impaired children in both categories increased slightly (by 3%, and 1%, resp., NS).

CONCLUSION

During the study period, SNM declined continuously, especially in the ELBW category. We managed to partially reduce NM (CNS and early infection), the problem remained late infection. In the period 2000-2007, incidence of DIs decreased, significantly in case of CP and visual impairment in ELBW children. Surprisingly in the last two years 2008-2009, there appeared in both categories an increase in the proportion of children with disabilities. It is a worrying finding, which should be re-evaluated.