Survival rate and 2 year outcome in very low birthweight infants.

The purpose of this study was to determine the mortality rate of 282 infants with a birthweight (BW) of < 1,500 g during a 5 year period (1987-92), and to evaluate 2 year neurodevelopmental outcome in 114 infants (born 1987-90) and its correlation with intracranial pathologies diagnosed by ultrasonography. Overall survival rate was 76.6% (216/282). With the introduction of exogenous surfactant therapy in 1991 a significant increase in survival was noted in the 751-1,000 g BW infants (from 20/36 to 20/22, P < 0.002). Two year evaluation was performed in 114 of 119 infants (95.7%) who survived this age. Twenty-two children (22/114, 19.3%) were functionally disabled, of whom 15 (13%) had a major disability. Of these 15 infants, 5/28 weighed < 1,000 g and 10/86 weighed 1,001-1,500 g (P = 0.6). Severe intraventricular hemorrhage (IVH) and cystic periventricular leukomalacia (PVL) were significantly associated with adverse outcome at 2 year (5/11 and 10/10 respectively were handicapped, P < 0.001). We therefore conclude that every effort should be made to save the extremely premature infants (< 1,000 g BW). Since adverse outcome was significantly associated with severe brain pathologies (large IVH and cystic PVL) rather than with lower BW, brain ultrasonography as a diagnostic mode should be taken into clinical consideration.