Neuropsychic follow-up of the premature infant: mortality, severe sequelae, early diagnosis and prognosis
Pediatr Med Chir, 4 (6):
621--633 (1982)Abstract
Neurological prospective follow-up study of premature newborns must be carried out to determine the usefulness and efficacy of modern perinatal intensive care. Over the last 30 years an improvement in perinatal care has led to a dramatic reduction from 70\% to 20\%-40\% in mortality rate among VLBW infants (less than or equal to 1500 g); while among those weighing less than or equal to 1000 g the mortality rate has dropped below 60\% in some intensive care units. The concentration of high-risk pregnancies and deliveries in the same hospital in which the premature is cared for has led to a further reduction in the neonatal mortality rate. Most, though not all, foreign research reports a lower handicap rate than prior to the era of newborn intensive care. Studies from newborn intensive care units show considerable variation in the rates of handicaps among surviving LBW infants. Studies carried out at the same time in intensive care units and in routine care units reveal a higher or equal handicap percentage among those from intensive care units. It should be however remembered that the sometimes higher handicap rate is linked to a considerably increased survival rate and the gain in healthy lives saved is considerable. A recent comparison made in various european, american and australian centres reveals an average of 7\% of cerebral palsy and 15\% of mental retardation among VLBW (less than or equal to 1500 g) infants. In recent years there has been a dual tendency towards a stabilisation in the frequency of handicaps and a reduction in the gravity of the worst handicaps. Over the last 10 years there has been a renewed increase in retrolental fibroplasia: as much as 5-11\% in VLBW infants less than or equal to 1000 g. Squint is the other most frequent visual defect. Hearing defects vary from 1,8\% to 15\%. Posthemorrhagic Hydrocephalus which takes place either early or later in the neonatal period is the most frequent complication of intraventricular haemorrhages and the prognosis depends on the gravity of the haemorrhage. Epilepsy is rare; spastic diplegia, now almost always accompanied by normal intellectual development, though considerably less frequent than in the past, is still the most frequent form of cerebral palsy. Serious mental retardation is present only among one third-one quarter of major handicaps.(ABSTRACT TRUNCATED AT 400 WORDS)