Mortality and two year outcome of infants of birthweight 500‐1500 g: relationship with neonatal cerebral ultrasound data

Abstract

Cranial ultrasounds were performed on 218 (96%) of 227 liveborn infants of birthweight 500‐1500 g delivered in the Royal Women's Hospital, Melbourne, Australia, in an 18‐month period concluding in March 1982. Seventy‐two (31.7%) of the children died; 28 children (38.9%) had cerebroventricular haemorrhage, 35 (48.6%) showed no bleeding and there were nine (12.5%) with no data. Paired necropsy and ultrasound data were congruent in 22 (88%) of 25 children. One hundred and forty‐eight (95.5%) of 155 survivors were seen at 2 years of age. Forty‐one (28%) had cerebroventricular haemorrhage; nine children (6%) had both ventricular dilatation and haemorrhage and two had ventricular dilatation alone. Apart from a marginal advance in gestation and higher number of immigrant and less educated mothers in children without cerebroventricular haemorrhage, all other perinatal, biographical and social variables between those with haemorrhage and those without were similar. The major handicap rate overall was 14.2% (21 patients). The children with cerebroventricular haemorrhage had a trend for greater prevalence of handicap and lower mean Bayley psychological scores. This was even more evident with ventricular dilatation being present. Of children with major handicap 57.1% (12/21) had normal serial ultrasound findings during their primary hospitalization. Major handicap occurred in 15% (3/20) of children with grade 1 haemorrhage, 23.5% (4/17) with grade 2 or 3 bleeds and 25% (1/4) of those with grade 4 haemorrhage. Laterality of cerebral palsy did not correlate with ultrasound findings. Ultrasound findings did not improve statistical prediction of deaths or major handicap.

Changes in lung function between age 8 and 14 years in children with birth weight of less than 1,501 g

“…Between January 1, consecutive livebirths with birth weights 1,000-1,500 g survived. Details of the early neonatal care 4,5 of these cohorts have been described. These children received intermittent positive pressure ventilation (IPPV) via an endotracheal tube with a pressure-limited, time-cycled ventilator.…”

Survival, cranial ultrasound and cerebral palsy in very low birthweight infants: 1980s versus 1990s

“…Other details of the technique for scanning for the children in the first era have been described. 3,8 Infants in the second era were scanned with an ATL Ultrasound Mark 8 with a 7.5 MHz mechanical sector probe; cystic PVL could be detected. The frequency of scanning was less than in the first era, but comprised as a minimum scan by 3 days of age, another by 1 week of age, and another prior to discharge from the nursery.…”

“…Cerebroventricular haemorrhage was classified as that by Papile et al , 9 however for infants who died in 1980–82, the Papile stages 2 and 3 had been combined. 3 …”

“…Although there was a relationship between CP and CVH, the relationship was not absolute, with the majority of survivors with CVH not having CP, and the majority of survivors with CP having had no CVH. 3 Since the mid‐1980s cystic periventricular leucomalacia (PVL) has been detected with improvements in cranial ultrasound technology. Cystic PVL has a stronger association with CP, but again is still not absolute, varying with the site and extent of the PVL.…”

Methylxanthines and sensorineural outcome at 14 years in children < 1501 g birthweight

“…Cranial ultrasonography was routine and extensive at this time, and the frequency, findings and follow‐up data earlier in childhood have been reported. 16–18 Data for pCO 2 were not recorded.…”