premature infant outcomes linda wallen, md. prevalence of cerebral palsy vlbw infants - 1982-1994...

Premature Infant OutcomesPremature Infant OutcomesPremature Infant OutcomesPremature Infant Outcomes

Linda Wallen, MDLinda Wallen, MD

Prevalence of Cerebral Palsy Prevalence of Cerebral Palsy VLBWVLBW Infants - 1982-1994 Infants - 1982-1994

Prevalence of Cerebral Palsy Prevalence of Cerebral Palsy VLBWVLBW Infants - 1982-1994 Infants - 1982-1994

Mortality Cerebral Palsy(% live births) (% survivors)

1982-1984 36.8 9.1

1984-1986 31.5 12.3

1986-1988 36.1 11.9

1988-1990 29.2 9.2

1990-1992 21.8 3.6

1992-1994 13.8 6.6(O’Shea et al., 1998)

Survival & Outcome of Infants Weighing <800 g Survival & Outcome of Infants Weighing <800 g 1979 to 19941979 to 1994

Survival & Outcome of Infants Weighing <800 g Survival & Outcome of Infants Weighing <800 g 1979 to 19941979 to 1994

(O’Shea et al., Pediatrics 100: 982-986, 1997)

Dates(n)

Survival% (n)

CLD(% surv)

G 3 IVH/IPE(% surv)

Rehospital(% surv 1 yr)

1979-1984(120)

20 (24) 23 10 29

1984-1989(175)

36 (63) 66 21 49

1989-1994(218)

59 (129) 61 12 53

Survival & Outcome of Infants, 401-1250 g Survival & Outcome of Infants, 401-1250 g 1994 to 19961994 to 1996

Survival & Outcome of Infants, 401-1250 g Survival & Outcome of Infants, 401-1250 g 1994 to 19961994 to 1996

(Finer et al., Pediatrics 104: 428-434, 1999)

BW (g)(n)

Survival% (n)

Severe IVH(n)

% w/o Sev IVH % (n)

401-500(497)

17 (82) 6 15 (76)

501-750(5334)

60 (3110) 380 52 (2730)

751-1000(6336)

89 (5501) 370 82 (5131)

1001-1250(7201)

96 (6739) 285 92 (6454)

Survival & Outcome of Infants, < 1250 g Survival & Outcome of Infants, < 1250 g Doernbecher NCC, 1995 to 1998Doernbecher NCC, 1995 to 1998

Survival & Outcome of Infants, < 1250 g Survival & Outcome of Infants, < 1250 g Doernbecher NCC, 1995 to 1998Doernbecher NCC, 1995 to 1998

BW (g)(n)

Survival% (n)

SevereIVH (n)

< 500 g(11)

63 (7) 0

500-749(57)

72 (41) 5

750-999(104)

94 (98) 11

1000-1249(107)

96 (103) 10

Bayley Scales at 30 Months for Infants Born at Bayley Scales at 30 Months for Infants Born at < 26 Weeks Gestation< 26 Weeks Gestation

Bayley Scales at 30 Months for Infants Born at Bayley Scales at 30 Months for Infants Born at < 26 Weeks Gestation< 26 Weeks Gestation

(EPIcure Group (UK) follow up Mar-Dec 1995. New England J Med 343:381, 2000)

Individual Scores on Bayley Scales at 30 months by Gestational Age

From NICHD Network 1993-1994 Follow-Up. Pediatrics. 105:1221-22, 2000.

Adj. Risk for No Independent Walking Adj. Risk for No Independent Feeding

Risk Factors for Cerebral Palsy in Infants Risk Factors for Cerebral Palsy in Infants < < 1000 g at 18-22 Months1000 g at 18-22 Months

Risk Factors for Cerebral Palsy in Infants Risk Factors for Cerebral Palsy in Infants < < 1000 g at 18-22 Months1000 g at 18-22 Months

From NICHD Network 1993-1994 Follow-Up. Pediatrics. 105:1220-21, 2000.

Adjusted Risk Factors for MDI < 70 Adjusted Risk Factors for PDI < 70

Risk Factors for Severe Developmental Delay Risk Factors for Severe Developmental Delay in Infants in Infants <<1000 g at 18-22 Months1000 g at 18-22 Months

Risk Factors for Severe Developmental Delay Risk Factors for Severe Developmental Delay in Infants in Infants <<1000 g at 18-22 Months1000 g at 18-22 Months

Died (2%)

No disability (49%)

No data (1%)

Other disability (25%)

Severe disability (25%)

(EPIcure Group (UK) follow up Mar-Dec 1995. New England J Med 343:381, 2000)

30 Month Outcome for Infants Born at < 26 Weeks30 Month Outcome for Infants Born at < 26 Weeks30 Month Outcome for Infants Born at < 26 Weeks30 Month Outcome for Infants Born at < 26 Weeks

From NICHD Network 1993-1994 Follow-Up. Pediatrics. 105:1221-22, 2000.

NICHD Outcome of Infants 401-1000 g at DischargeNICHD Outcome of Infants 401-1000 g at DischargeNICHD Outcome of Infants 401-1000 g at DischargeNICHD Outcome of Infants 401-1000 g at Discharge

BW (g) (n) Post-NeoSurvival %

CLD%

Steroid Rx %

Grade 3-4IVH/PVL %

Hosp dMedian

501-600 (94) 98 51 68 16 119

601-700 (205) 96 49 59 23 109

701-800 (227) 98 45 50 22 99

801-900 (276) 97 36 38 18 84

901-1000 (295) 96 30 28 15 73

401-1000 (1111) 97 40 44 18 92

NICHD Outcome of Infants 401-1000 g at 18 MonthsNICHD Outcome of Infants 401-1000 g at 18 MonthsNICHD Outcome of Infants 401-1000 g at 18 MonthsNICHD Outcome of Infants 401-1000 g at 18 Months

BW (g) (n) CP%

Blind%

HearingLoss %

NormalExam %

501-600 (94) 17 10 11 71

601-700 (205) 21 12 14 70

701-800 (227) 17 13 9 72

801-900 (276) 15 5 9 79

901-1000 (295) 15 5 7 79

401-1000 (1111) 17 9 11 75

From NICHD Network 1993-1994 Follow-Up. Pediatrics. 105:1221-22, 2000.

BW (g) (n) MDIMn (SD)

PDIMn (SD)

MDI %< 70 <85

PDI %< 70 <85

501-600 (94) 73 (16) 75 (19) 45 70 34 65

601-700 (205) 74 (16) 76 (19) 41 72 35 62

701-800 (227) 74 (17) 77 (18) 42 68 31 50

801-900 (276) 77 (17) 80 (18) 35 67 25 52

901-1000 (295) 79 (18) 80 (18) 31 58 25 53

401-1000 (1111) 76 (17) 78 (18) 37 66 29 57

NICHD Outcome of Infants 401-1000 g at18 MonthsNICHD Outcome of Infants 401-1000 g at18 MonthsNICHD Outcome of Infants 401-1000 g at18 MonthsNICHD Outcome of Infants 401-1000 g at18 Months

From NICHD Network 1993-1994 Follow-Up. Pediatrics. 105:1221-22, 2000.

Growth Failure in the ELBW InfantGrowth Failure in the ELBW InfantGrowth Failure in the ELBW InfantGrowth Failure in the ELBW Infant Growth at 1 yr of infants 501-800 g born 1989-1994Growth at 1 yr of infants 501-800 g born 1989-1994

– Head circumference < 10% = 35% (45/219)Head circumference < 10% = 35% (45/219)– Weight < 10% = 58% (75/219)Weight < 10% = 58% (75/219)– Length < 10% = 33% (42/219)Length < 10% = 33% (42/219)

Growth at 6-7 yr of infants < 750 g born 1982-86Growth at 6-7 yr of infants < 750 g born 1982-86– Head circumference < 3% = 35% (24/68)Head circumference < 3% = 35% (24/68)– Weight < 3% = 22% (15/68)Weight < 3% = 22% (15/68)– Height < 3% = 25% (17/68)Height < 3% = 25% (17/68)

Growth at 6-7 yr of infants 750-1499 g born 1982-86Growth at 6-7 yr of infants 750-1499 g born 1982-86– Head circumference < 3% = 14% (9/65)Head circumference < 3% = 14% (9/65)– Weight < 3% = 11% (7/65)Weight < 3% = 11% (7/65)– Height < 3% = 5% (3/65)Height < 3% = 5% (3/65)

Outcomes of ELBW infantsOutcomes of ELBW infantsOutcomes of ELBW infantsOutcomes of ELBW infants

Historical reasons for reliance on neurologic morbiditiesHistorical reasons for reliance on neurologic morbidities

– Public misperception of prevalence of severe disabilityPublic misperception of prevalence of severe disability

– Limitation of range of outcomes studiedLimitation of range of outcomes studied Other health outcomes that are affectedOther health outcomes that are affected

– Increased incidence of asthmaIncreased incidence of asthma

– Increased visual perceptual & expressive language disabilitiesIncreased visual perceptual & expressive language disabilities

– Increased behavioral problemsIncreased behavioral problems

– Growth failureGrowth failure

– Family and child perception of health and outcomeFamily and child perception of health and outcome

– Psychological outcomesPsychological outcomes Other factors which influence outcome = risk factors and post discharge Other factors which influence outcome = risk factors and post discharge

environment, heavily influenced by maternal education, income level, environment, heavily influenced by maternal education, income level, smoking, poor maternal health (physical or mental)smoking, poor maternal health (physical or mental)