Strategies for the Care of the Very Low Birthweight Infant. Abstract, ExecutiveSummary and Final Report

摘要

The late consequences of intensive care of very low birthright infants ((VLBW), <1,500g at birth) are not well established. We examined five large population-based cohorts of VLBW infants (USA, Canada, Holland, Germany, Jamaica) assessed at school age to establish the nature and frequency of these to variations in intensiveness of neonatal care. All cohorts showed high rates of disabling cerebral palsy (DCP), mental retardation, school problems and behavioral difficulties. Among infants < 1,000g, a remarkably similar pattern of behavioral disorder-which included hyperactivity/attention deficit, thought disorders and social problems-was found internationally. Mechanical ventilation, when associated with hypocapnia, was associated with elevated risk of DCP in the US. Management of infants 23-26 weeks GA differed sharply across cohorts, with near universal mechanical ventilation in the US, but selective ventilation in Holland; mortality was lower in the US, but DCP rates were much higher. Perceived quality of life in VLBW survivors was found to depend upon the reporter (physician, patient, teen survivor) in Canada, and on method of ascertainment in Holland. Management of the VLBW infant continues to raise ethical dilemmas that cannot be resolved by physicians alone.