Follow up of very low birth weight (VLBW) premature infants: results and consequences

Objectives: What will be the outcome of VLBW premature infants? That not only parents but also staffs of clinics and out-patient departments were asking with worry. Because VLBW premature infants with poor outcome were treated particulary in departments of pediatric neurology, it makes sense to present own results and to compare to literature. The data are supplied by experiences of a pediatric neurologist working in a neonatal intensive care unit (NICU).

Material and Methods: 266 (85%) of 314 premature infants <1500g birth weight or gestational age <32 weeks, born and treated in the NICU of the FU Berlin 1991–1995, were examined up to sixth year of life: neurological status, motoric and mental development (Bayley I, K-ABC) and behaviour disturbance.

Results: see table.

	normal	abnormal	pathological	total (numbers)
<750g	35%	30%	35%	23
750–999g	51%	28%	21%	67
1000–1249g	50%	33%	17%	70
1250–1499g	71%	20%	9%	66
>1499g, <32 wks	33%	15%	52%	40
<32 wks	52%	25%	23%	266

Definitions: “pathological“=cerebral palsy, severe developmental or behaviour disturbance, mental disability, severe somatic handicap (i.e., blindness); “abnormal“=mild to moderate developmental delay, disturbances of coordination, behaviour, cognition or learning; “normal“=no problems.

Conclusions: Complete follow up needs a lot of time, personnel and staying power. It is necessary as quality control. It is also necessary to detect developmental and behaviour disturbances early, because the care for these children must not end with discharge. The majority of VLBW premature infants doesn't have a disability, but, about 50% of patients have a disturbance of development or behaviour (“new disorders“), which becomes better with growing up and support. The data of the literature are simplified by means of “one sixth-rule“: one sixth is disabled, three sixths have disturbances of development or behaviour and two sixths are normal. The own results demonstrate, that more VLBW premature infants can develop normally. It is possible that this is the result of conservative neonatological management, including critical review of all interventions with regard to proven effectivity. Because mistakes in neonatology were made more easily by doing to much than to less.