Outcome of extremely low birth weight infants

Abstract

Due to progress in treatment modalities the chances of survival for extremely premature neonates improved significantly over the last 20 years. The limits of viability lie between 23 and 24 completed weeks of gestational. There are even anecdotal reports of survival at 22 weeks of gestation. Multiple complications do influence the neurological outcome of very small premature neonates. Despite prenatal corticoids and postnatal surfactant application many premature infants develop bronchopulmonary dysplasie, with pulmonary problems up to adulthood. Approx. 6% of infants develop Necrotizing enterocolitis with possible development of short gut syndrome and nutritional growth disturbance. Sensoric impairment, such as deafness or blindness also complicates the development of premature infants. Early recognition of the retinal changes of retinopathy of prematurity and timely treatment with laser-coagulation or cryotherapy will prevent blindness, but residual risk for a partial loss of visual acuity remains. The risk for severe intracranial haemorrhage and for the development of periventricular leucomalacia increases with decreasing gestational age. Posthaemorrhagic hydrocephalus and cerebral paresis can be the consequences. An important aspect of the treatment and care of extremely premature infant concerns the long term neurologic outcome. The neurologic outcome lies in the center of parental concern. No standardized long term outcome data base exists for Germany. Only such data can be the basis for decision making at the limit of viability.