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ORIGINAL RESEARCH |
From the University of Southern California Keck School of Medicine; and Division of Neonatology, Department of Pediatrics, and Department of Pathology, Women’s and Children’s Hospital, Los Angeles County + University of Southern California Medical Center, Los Angeles, California.
Address reprint requests to: Joan E. Hodgman, MD, Women’s and Children’s Hospital, Division of Neonatology, 1240 North Mission Road, Room L-919, Los Angeles, CA 90033; E-mail: hodgman{at}hsc.usc.edu.
OBJECTIVE: To assess the neurologic and developmental outcome at 2 years of age in preterm infants with birth weights 600 g or lower.
METHODS: We conducted a retrospective review from January 1994 through December 1998 for placental histopathology, maternal factors, neonatal intensive care unit course, growth, neurologic/special sense status, and development at 2 years of age corrected for prematurity.
RESULTS: Of the 104 neonates weighing 600 g or less, 24 survived to nursery discharge (23%). Two infants died of chronic lung disease after discharge, and 21 of the remaining 22 infants (95%) returned for follow-up. Placental pathology was available for 21 (95%); acute inflammation was present in 67%, and other abnormalities occurred in 76%. Mean birth weight was 537 (430–600) g, and mean gestational age was 24 (22–27) weeks. At birth, 55% were below the tenth percentile for birth weight. At nursery discharge and 2 years of age, 94% were below the tenth percentile for weight, length, and head circumference. Nineteen of 21 (90%) infants were abnormal on neurodevelopmental follow-up. Major problems were cerebral palsy, blindness, gastrostomies, and ventriculoperitoneal shunts.
CONCLUSION: Abnormal placental histology was present in all but one infant, suggesting fetal injury before birth. Only eight of 20 infants with chorioamnionitis were diagnosed clinically, and all infants had a complicated course. We found a high incidence of intrauterine growth restriction and an almost universal pattern of impaired postnatal growth with extremely poor neurodevelopmental outcome at 2 years of age.
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