Longitudinal predictors of psychiatric disorders in very low birth weight adults.

The purpose of this study was to determine risk and protective factors for adult psychiatric disorders in very low birth weight (VLBW, birth weight <1,501 g) survivors. 79 of 154 (51%) VLBW subjects recruited at birth were assessed in early adulthood (24-27 years). Participants were screened for a psychiatric disorder; those elevated were invited to attend a structured clinical interview to determine a clinical diagnosis. Longitudinal variables measured from birth and at ages 2, 5, 14 and 18 years were included in analyses. Perinatal, developmental and social environmental risk factors failed to predict psychiatric disorder in adulthood in this cohort of VLBW survivors. Instead, low self-esteem at age 18 (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 1, 1.11, p = 0.05) and the adult social environment (high rates of negative life event stress at the time of assessment: OR = 1.39, CI = 1.10, 1.76, p = 0.02), contributed significantly to adult psychiatric outcomes.

Extremely low birth weight and body size in early adulthood.

AIMS: To determine the body size of extremely low birth weight (ELBW, birth weight 500-999 g) subjects in early adulthood. METHODS: Cohort study examining the height and weight of 42 ELBW survivors free of cerebral palsy between birth and 20 years of age. Weight and height measurements were converted to Z (SD) scores. RESULTS: At birth the subjects had weight Z scores substantially below zero (mean birth weight Z score -0.90, 95% CI -1.25 to -0.54), and had been lighter than average at ages 2, 5, and 8 years. However, by 14, and again at 20 years of age their weight Z scores were not significantly different from zero. At ages 2, 5, 8, 14, and 20 years of age their height Z scores were significantly below zero. Their height at 20 years of age was, however, consistent with their parents' height. As a group they were relatively heavy for their height and their mean body mass index (BMI) Z score was almost significantly different from zero (mean difference 0.42, 95% CI -0.02 to 0.84). Their mean BMI (kg/m2) was 24.0 (SD 5.2); 14 had a BMI >25, and four had a BMI >30. CONCLUSIONS: Despite their early small size, by early adulthood the ELBW subjects had attained an average weight, and their height was consistent with their parents' height. They were, however, relatively heavy for their height.

Children followed with difficulty: how do they differ?

OBJECTIVE: To determine if very low birthweight children followed with ease differ in any perinatal or sociodemographic characteristics, or outcomes, compared with children followed with more difficulty. METHODOLOGY: Consecutive children of birthweight < 1000 g or with gestational ages < 28 weeks born in 1991 (n = 51) or of birthweight < 1500 g born in 1992 (n = 166) at the Royal Women's Hospital, Melbourne, surviving to 5 years of age, were assessed at 5 years of age, corrected for prematurity. Those who attended on the first mutually agreed appointment without substantial reluctance were considered to have been followed with ease. The remainder were considered to have been followed with difficulty. Outcomes included impairments such as cerebral palsy, blindness, deafness, and low IQ. Children had a disability if they had any of cerebral palsy, blindness, deafness requiring amplification, or an IQ more than 1 SD below the mean. RESULTS: Of the 217 survivors, 204 (94%) were assessed fully at 5 years of age. Of the 204 children assessed, 153 (75%) were followed with ease, and 51 (25%) with difficulty. Of data available in the perinatal period, significantly fewer children followed with more difficulty came from intact families, and more of their mothers had fewer than 12 years of schooling. More children followed with difficulty had a disability (41% compared with 19%), as they predominantly had lower IQ scores (mean difference in IQ - 12.7, 95% confidence interval - 18.0, - 7.4). The association between difficulty of assessment and both higher rates of disability and lower IQ scores remained after adjustment for significant perinatal and sociodemographic variables. CONCLUSIONS: Children followed with difficulty can partly be recognized on several sociodemographic characteristics in the perinatal period, and have substantially worse sensorineural outcomes than those followed with ease. In any longitudinal study, the more incomplete the follow up, the lower will be the rate of adverse sensorineural outcome.

Auditory function at 14 years of age of very-low-birthweight.

The aim of the study was to determine audiological function at 14 years of age of very-low-birthweight (VLBW < or = 1500 g) children compared with a cohort of normal birthweight (NBW > 2499 g) children. Participants were consecutive surviving preterm children of birthweight < 1000 g born between 1977 and 1982 (n=86) and of birthweight 1000 to 1500 g born between 1980 and 1982 (n=124) and randomly selected NBW children born between 1981 and 1982 (n=60). Audiometric tests included pure tone audiometry, tympanometry, stapedius muscle reflexes, and measures of central auditory processing. Psychometric tests included measures of IQ, academic achievement, and behaviour. There were no significant differences in rates of hearing impairment, abnormal tympanograms, figure-ground problems, or digit recall between VLBW children and NBW control children. VLBW children had higher rates of some central auditory processing problems, which in turn were associated with poorer intellectual, academic, and behavioural progress.

Cognition, academic progress, behavior and self-concept at 14 years of very low birth weight children.

The aim of this study was to compare cognition, academic progress, behavior, and self-concept children of very low birth weight (VLBW, birth weight < 1501 g) born in the period 1980 to 1982 with randomly selected children of normal birth weight (NBW, birth weight > 2,499 g). At 14 years of age, 130 (84.4%) of 154 VLBW and 42 (70.0%) of 60 NBW children were assessed. Ten VLBW children and one NBW child who had cerebral palsy were excluded. VLBW children scored at a significantly lower level on all three composite scales of the Wechsler Intelligence Scale for Children, 3rd Edition. VLBW children were also significantly disadvantaged on more specific cognitive processes, including tests of visual processing and visual memory and on subtests reflecting learning and problem solving. Only in arithmetic was a difference between the groups discerned on tests of achievement. Significantly more VLBW children were rated by teachers as socially rejected and by their parents as having learning problems at school. VLBW children had significantly reduced self-esteem. VLBW children had more cognitive, academic, and behavioral problems and lower self-esteem at 14 years of age than NBW control subjects.

Birth weight <1501 g and respiratory health at age 14.

AIMS: To determine the respiratory health in adolescence of children of birth weight <1501 g, and to compare the results with normal birthweight controls. METHODS: Prospective cohort study of children born in the Royal Women's Hospital, Melbourne. Two cohorts of preterm children (86 consecutive survivors 500-999 g birth weight, and 124 consecutive survivors 1000-1500 g birth weight) and a control group of 60 randomly selected children >2499 g birth weight were studied. Children were assessed at 14 years of age. A paediatrician determined the clinical respiratory status. Lung function was measured according to standard guidelines. RESULTS: Of 180 preterm children seen at age 14, 42 (23%) had bronchopulmonary dysplasia (BPD) in the newborn period. Readmission to hospital for respiratory ill health was infrequent in all groups and the rates of asthma were similar (15% in the 500-999 g birth weight group, 21% in the 1000-1500 g birth weight group, 21% in controls; 19% BPD, 18% no BPD). Overall, lung function was mostly within the normal range for all cohorts; few children had lung function abnormalities in clinically significant ranges. However, the preterm children had significantly lower values for variables reflecting flow. Lung function in children of 500-999 g birth weight was similar to children of 1000-1500 g birth weight. Preterm children with BPD had significantly lower values for variables reflecting flow than children without BPD. CONCLUSIONS: The respiratory health of children of birth weight <1501 g at 14 years of age is comparable to that of term controls.

Very low birth weight and growth into adolescence.

OBJECTIVE: To compare the growth and pubertal development of very low-birth-weight (VLBW) children (birth weight <1500 g) and normal-birth-weight (NBW) children (birth weight >2499 g) to adolescence to determine if, and at what age, VLBW children "catch up." DESIGN: Inception cohort study to age 14 years. SETTING: Royal Women's Hospital, Melbourne, Australia. PATIENTS: Eighty-six consecutive survivors with a birth weight less than 1000 g, 120 consecutive survivors with a birth weight of 1000 to 1499 g, and 60 randomly selected NBW controls. Children with cerebral palsy at age 14 years were excluded. MAIN OUTCOME MEASURES: Weight, height, and head circumference measurements at birth and ages 2, 5, 8, and 14 years converted to z (SD) scores. RESULTS: At age 14 years, pubertal development was similar in NBW and VLBW children. At ages 2, 5, 8, and 14 years, VLBW children were significantly shorter and lighter and had smaller head circumferences than NBW children. The differences in height and weight between VLBW and NBW children were less apparent as SD scores improved in VLBW children over time. Within the VLBW group, compared with children with a birth weight of 1000 to 1499 g, those with a birth weight less than 1000 g had significantly lower weight z scores earlier in childhood but not at age 14 years, significantly lower height z scores only at age 2 years, and significantly lower head circumference z scores throughout childhood. CONCLUSION: This group of VLBW children experienced late catch-up growth to age 14 years but remain smaller than their NBW peers. Arch Pediatr Adolesc Med. 2000;154:778-784

Antenatal corticosteroids and outcome at 14 years of age in children with birth weight less than 1501 grams.

OBJECTIVE: To determine whether exposure to antenatal corticosteroid therapy was associated with adverse effects on growth, sensorineural outcome, or lung function of children of birth weight <1501 g at 14 years of age. DESIGN: Cohort study. SETTING: The Royal Women's Hospital, Melbourne, Australia. SUBJECTS: One hundred fifty-four consecutive survivors born from October 1, 1980 to March 31, 1982. INTERVENTIONS: The mothers of 78 survivors (51%) had been given corticosteroids antenatally to accelerate fetal lung maturation. Treatment with antenatal corticosteroids was nonrandom. No mother received >1 course of corticosteroids. OUTCOME MEASURES: The children were assessed at 14 years of age, corrected for prematurity. All assessors were unaware of the exposure of the child to antenatal corticosteroids. The assessments included measurements of growth and neurological, cognitive, and lung function. Growth measurements were converted into z scores (standard deviation) for the appropriate age and gender. RESULTS: Of the 154 survivors, 130 (84%) were assessed at 14 years of age. Overall, the children exposed to antenatal corticosteroids were significantly taller (height z score; mean difference:.39; 95% confidence interval:.001-. 79) and had better cognitive functioning (Wechsler Intelligence Scale for Children-Third Edition Full Scale; IQ mean difference: 6. 2; 95% confidence interval:.8-11.6) than those not exposed to corticosteroids. There were no other differences in sensorineural outcomes between the groups. Lung function was not significantly different between the groups. No conclusions were altered by adjustment for confounding variables. CONCLUSIONS: Exposure to 1 course of antenatal corticosteroid therapy was associated with some clinically and statistically improved outcomes at 14 years of age in children of birth weight <1501 g, with no obvious adverse effects on growth or on sensorineural, cognitive, or lung function. corticosteroids, growth, cognitive, IQ, lung function, adolescence.

Survival, cranial ultrasound and cerebral palsy in very low birthweight infants: 1980s versus 1990s.

OBJECTIVE: To determine the changes in the rates of survival, cranial ultrasound abnormalities and cerebral palsy in very low birthweight (VLBW) (birthweight 500-1499 g) infants between the early 1980s and the early 1990s. METHODOLOGY: A cohort study of consecutive VLBW live births in one tertiary perinatal hospital during two distinct eras was performed at The Royal Women's Hospital, Melbourne, a level-III perinatal centre. Consecutive VLBW infants born over the 18-month period from 1 October 1980 (n = 222), and over the 12-month period from 1 January 1992 (n = 202) were identified. The main outcome measures were the proportions of live births surviving to 5 years of age, rates of cranial ultrasound abnormalities, and rates of cerebral palsy at 5 years of age. RESULTS: Over the 18 months from 1 October 1980, 68% (150/222) VLBW live births survived to 5 years of age. The survival rate rose substantially to 82% (165/202) during 1992 (odds ratio 2.1, 95% confidence interval 1.4-3.2). The survival rate increased over time more for those of 500-999 g birthweight than for those of 1000-1499 g birthweight. The rates of cerebroventricular haemorrhage (CVH) were similar inlive births and survivors from both eras, as were the rates of cerebral palsy (7.5% in 1980-82; 7.8% in 1992) in survivors seen at 5 years of age. The positive predictive value of CVH for cerebral palsy was low, but cystic periventricular leucomalacia was followed by cerebral palsy in seven of eight survivors from the 1992 cohort. CONCLUSIONS: Despite the increasing survival rate with improvements in perinatal care, including more antenatal steroid therapy and the introduction of exogenous surfactant, the rates of CVH and of cerebral palsy in survivors have not diminished.

Methylxanthines and sensorineural outcome at 14 years in children < 1501 g birthweight.

OBJECTIVES: Methylxanthines, including theophylline, have been used extensively and successfully to treat apnoea in preterm infants. However, long-term consequences of such therapy are largely unknown. The aim of this study was to determine the relationship between theophylline therapy and outcome at 14 years of age in surviving preterm children of birthweight < 1501 g. METHODOLOGY: The subjects of this study were 154 consecutive survivors with birthweights < 1501 g born from 1 October 1980 to 31 March 1982; 130 (84.4%) were assessed at 14 years of age. Outcomes included motor function, psychological test scores, and growth. RESULTS: Of the 130 children assessed, 69 (53.1%) had been exposed to theophylline; 13.0% had cerebral palsy, significantly higher than 1.6% in the 61 children not exposed to theophylline (P < 0.02). This difference remained statistically significant after adjusting for potential confounding variables including the presence of cerebroventricular haemorrhage. In contrast, after adjusting for known confounding variables, children who had received theophylline achieved higher psychological test scores. There was no association between theophylline therapy and growth. CONCLUSIONS: Theophylline therapy in the newborn period is associated with some evidence of harmful, but also helpful sensorineural effects at 14 years of age.

Urban/rural and gender differentials in suicide rates: east and west.

BACKGROUND: Many epidemiological studies indicate suicide rates are higher for males than females and for urban than rural. Here we re-examine gender, urban and rural differentials in suicide in Australia and Beijing (China). More specifically, to test the two hypotheses (i) that the male to female ratio is larger than one; (ii) that the urban suicide rate is higher than the rural in both places. METHODS: Suicide data with information of gender, rural and urban regions for Australia and Beijing (China) for the period of 1991-1996 were used. Ratios between the gender-specific urban and rural suicides rates with the associated confidence intervals were constructed to examine gender, urban and rural differentials in Australia and Beijing. RESULTS: The rural suicide rate in Beijing for both genders was higher than for their urban counterparts. Further, the elderly had the highest suicide rate followed by women aged 20-29. Also, the male to female ratio in China was less than one. In Australia, the rural male suicide rate was higher than the urban whereas the urban female suicide rate was higher than the rural. The male to female ratio was 4 to 1. The differences in rural to urban and male to female ratios between Australia and Beijing are statistically significant. CONCLUSIONS: In contrast to the west, male suicide rates are not higher than female rates in China. Urban rates are not necessarily higher than rural rates --not even in a western setting. Cultural factors and regional differences in socio-economic situation are significant in explaining the low gender ratio and the relatively higher suicide rates in rural China. LIMITATIONS: The suicide rate in the Beijing region might not exactly reflect the same for the whole of China.

Antenatal corticosteroid therapy and blood pressure at 14 years of age in preterm children.

Antenatal corticosteroid therapy substantially improves the survival rate of preterm infants, with few side effects. Higher blood pressure in adulthood has been described in several animal species after exposure to antenatal corticosteroids, but there are no similar reports in humans. The objective of the present study was to determine the relationship between exposure to antenatal corticosteroid therapy and blood pressure at 14 years of age. This was a cohort study of 210 preterm survivors with birthweights of <1501 g born in the Royal Women's Hospital, Melbourne, between 1 January 1977 and 31 March 1982. Blood pressure was measured in 177 subjects (84.3%) at 14 years of age with a standard mercury sphygmomanometer. Children exposed to antenatal corticosteroids (n=89) had higher systolic and diastolic blood pressures than those not exposed to corticosteroids (n=88) [mean difference (95% confidence interval) (mmHg): systolic, 4.1 (0.1-8.0); diastolic, 2.8 (0.05-5.6)]. However, few had blood pressure in the hypertensive range. It is concluded that antenatal corticosteroid therapy is associated with higher systolic and diastolic blood pressures in adolescence, and might lead to clinical hypertension in survivors well beyond birth.

Changes in lung function between age 8 and 14 years in children with birth weight of less than 1,501 g.

We set out to determine whether lung function of children with a birth weight of <1,501 g changed relative to expectations between the ages of 8 and 14 years. We hypothesized that changes in lung function may differ between those of birth weight above and below 1,000 g. The subjects of this study were born in the Royal Women's Hospital, Melbourne. There were 86 consecutive survivors with birth weights <1,000 g born between January 1, 1977 and March 31, 1982, and 124 consecutive survivors with birth weights 1,000-1,500 g born between October 1, 1980 and March 31, 1982. Lung function was measured at both age 8 and 14 years, corrected for prematurity in 78% (67/86) of those with birth weight <1,000 g, and in 69% (86/124) of those with birth weight 1,000-1,500 g. Overall, lung function was similar to predicted values at both 8 and 14 years of age [e.g., (forced expired volume in 1 s, FEV1% predicted) at age 8 years mean 88.5% (SD 14.7) and at age 14 years, mean 94.9% (SD 13.8)]. There were significant changes, mostly improvements, in lung function between age 8-14 years relative to predicted values: FEV1 (% predicted) increased between 8-14 years of age by a mean of 6.4 (95% confidence interval, 4.4-8.3). The improvements in some lung function variables were significantly greater in those of birth weight <1,000 g compared with those of birth weight 1,000-1,500 g: improvement in FEV1 (% predicted) between age 8-14 years in infants with birth weight <1,000 g had a mean of 10.3 (SD 13.1), and in those with birthweight 1,000-1,500 g a mean of 3.3 (SD 10.1). We conclude that lung function improved significantly relative to predicted values in children of birth weight <1,501 g between age 8-14 years. The improvements were greatest in those of birth weight <1,000 g.

Bronchopulmonary dysplasia and very low birthweight: lung function at 11 years of age.

OBJECTIVE: To determine the relationship between lung function at 11 years of age and bronchopulmonary dysplasia (BPD) in very low birthweight (VLBW) children. METHODOLOGY: This study comprised 154 consecutive surviving VLBW children, divided into three groups with respect to their neonatal respiratory morbidity: group I developed BPD; group II required assisted ventilation but did not develop BPD; and group III required no assisted ventilation. Lung function tests were measured on 120/154 (77.9%) children at 11 years of age. The relationship between various lung function variables and neonatal lung disease was analysed by multiple linear regression. RESULTS: Several lung function variables reflecting airflow were significantly diminished in the BPD group (n = 15), and residual volume was significantly higher. Despite poorer lung function overall, few children in the BPD group had lung function abnormalities in the clinically significant range (n = 2[13.3%] with a forced expired volume in 1 $ < 75% predicted; n = 2[13.3%] with a forced vital capacity < 75% predicted; n = 1 [6.7%] with a residual volume/total lung capacity > 35%). There were no significant differences in lung function variables between group II (n = 41) and group III (n = 64). Changes in lung function tests between 8 and 11 years did not very significantly between the three groups. CONCLUSIONS: VLBW children with BPD in the newborn period have period have poorer lung function at 11 years of age than other surviving VLBW children without BPD, although few have lung function abnormalities in the clinically significant range.

Passive smoking and respiratory function in very low birthweight children.

AIM: To determine if an adverse relationship exists between passive smoking and respiratory function in very low birthweight (VLBW) children at 11 years of age. SETTING: The Royal Women's Hospital, Melbourne. PATIENTS: 154 consecutive surviving children of less than 1501 g birthweight born during the 18 months from 1 October 1980. METHODS: Respiratory function of 120 of the 154 children (77.9%) at 11 years of age was measured. Exposure to passive smoking was established by history; no children were known to be actively smoking. The relationships between various respiratory function variables and the estimated number of cigarettes smoked by household members per day were analysed by linear regression. RESULTS: Most respiratory function variables reflecting airflow were significantly diminished with increasing exposure to passive smoking. In addition, variables indicative of air-trapping rose significantly with increasing exposure to passive smoking. CONCLUSION: Passive smoking is associated with adverse respiratory function in surviving VLBW children 11 years of age. Continued exposure to passive smoking, or active smoking, beyond 11 years may lead to further deterioration in respiratory function in these children.

The obstetrician and the extremely immature fetus (24-26 weeks): outcome to 5 years of age.

The aims of this study were to determine the outcome to 5 years of age for fetuses 24-26 weeks of gestational age from the obstetric viewpoint, and to determine if their outcome has improved over time. Consecutive fetuses with gestational ages from 24-26 weeks born at the Royal Women's Hospital, Melbourne, during 2 separate eras, Era 1 (1977-1982; n = 198) and Era 2 (1985-1987; n = 128) were studied and their outcome to 5 years of age determined. Fetuses referred with lethal malformations or clearly dead before the onset of labour were excluded. The stillbirth rates were similar in both eras (Era 1 23.7%, Era 2 21.9%), but the proportion of survivors to 5 years of age was much higher in Era 2 (Era 1 19.7%, Era 2 30.5%, X2 = 5.0, p < 0.03; odds ratio 1.80; 95% confidence interval [CI] 1.07 to 3.04). Overall, both the proportion and the absolute number of severely disabled children fell over time; 4 children survived with severe sensorineural disability in the 5 1/4 years of Era 1, but only one child in the 3 years of Era 2. From the obstetric viewpoint, only 1.5% of total births survived with a severe sensorineural disability, no higher than the rate expected for children born at term. Fetuses born at 24-26 weeks of gestational age need not contribute disproportionately to the number of severely disabled children in the community; furthermore, their outcome is improving over time. From the obstetrician's viewpoint, survival chances rather than sensorineural outcome should dominate decision-making at these extremely preterm gestations.

Assessment of short stature in very low birthweight children.

The aims of this study of short very low birthweight (VLBW) children at or after 8 years of age were to determine: (i) if there were any unsuspected organic causes for their growth failure; and (ii) whether any children might be suitable for treatment with synthetic growth hormone. Thirty-seven of 195 (19%) VLBW children seen at 8 years had heights < 10th centile, and of these only 40% (10/25) of families offered an assessment were concerned enough to have the child fully evaluated. No child had an unsuspected organic cause of short stature. The children's parents were significantly shorter than expected for Caucasians (mean parental height s.d. score = -1.06 (s.d. 0.72), t = -5.9, P < 0.001). On average, the bone age of the short children was delayed by 14.9 months (s.d. 18.8 months) compared with chronological age (t = -3.4, P < 0.01). When compared with their parents, the children's mean height s.d. score for their bone age was not significantly different (mean height s.d. score for bone age = -0.83 (s.d. 1.3), t = 0.6, NS). Only three children qualified for treatment with synthetic growth hormone; all three had been small for gestational age at birth and had birthweights < 1000 g. In conclusion, in short VLBW children, only a minority of families and children are likely to be concerned enough about short stature to be fully assessed; an unsuspected organic cause for growth failure is unlikely, and only a few will qualify for synthetic growth hormone therapy.

Cognition, school performance, and behavior in very low birth weight and normal birth weight children at 8 years of age: a longitudinal study.

Cognition, school performance, and behavior were assessed at 8 years of age in 132 very low birth weight (VLBW) children free of major sensorineural impairments, and the results were contrasted with a randomly selected control group of normal birth weight (NBW) children. Considering their fragile beginnings, the majority of VLBW children were developing normally and were reading and performing in most academic and social areas as well as the NBW children. However, VLBW children were significantly inferior to NBW children on tests of cognition, including tests of intelligence and visual memory, and on teacher's reports of motor skills and initiative. In addition, proportionally more VLBW children (20.5%) than NBW children (5.9%) were reported by their parents to be not coping at school.

Sensorineural outcome at 2 years for survivors of erythroblastosis treated with fetal intravascular transfusions.

OBJECTIVE: To determine the sensorineural outcome at 2 years of age in a complete cohort of survivors of fetal intravascular transfusions. METHODS: From March 1984 to May 1990, 38 of 52 consecutive fetuses (73%) suffering from severe erythroblastosis survived attempted intravascular transfusions at the Royal Women's Hospital, Melbourne. At 2 years of age, corrected for prematurity where appropriate, the survivors had a psychological assessment, including the mental developmental index of the Bayley scales, and a standardized neurodevelopmental examination. RESULTS: Only one transfused child had a severe sensorineural disability, with severe developmental delay and multiple minor motor seizures. Another child was moderately disabled with spastic hemiplegia. In neither case were complications of an intravascular transfusion the likely explanation for the disability. Only one other child had a mental developmental index in the suspect range. The remaining 35 children (92.1%) had no sensorineural disability. The overall rate of sensorineural impairments and disabilities was lower in the group transfused than in previous reports of survivors of intraperitoneal transfusions. The mean mental developmental index was significantly higher in the transfused group than in a control group of normal birth weight children. CONCLUSION: Children who survive fetal intravascular transfusions compare favorably not only with other high-risk survivors, but also with low-risk children.

The cost of improving the outcome for infants of birthweight 500-999 g in Victoria. The Victorian Infant Collaborative Study Group.

The aim of this study was to conduct an economic evaluation of neonatal intensive care for extremely low birthweight (ELBW) infants born in the state of Victoria. Two distinct eras (1979-80 and 1985-87) were compared. Follow-up data at 2 years of age were available for all 89 survivors from the 351 live births in 1979-80, and for 211 of 212 survivors from the 560 live births in 1985-87. The overall cost-effectiveness for ELBW infants during 1985-87 compared with 1979-80 was $104,990 ($A 1987) per additional survivor, or $5390 ($A 1987) per additional life year gained. Cost-effectiveness improved with increasing birthweight. If the quality of life of the survivors was considered, the economic outlook was more favourable. The cost per quality-adjusted life year gained was $5090 ($A 1987), approximately one-tenth of that obtained from the only previous full economic evaluation of neonatal intensive care. Although neonatal intensive care is expensive, it compares favourably with some other health care programmes, particularly as the outcome for ELBW infants continues to improve.