Risk-adjusted rates between hospitals for adverse outcomes of very-low-birth-weight infants.

BACKGROUND/PURPOSE: To analyze the amount of variation in these risk-adjusted adverse outcomes corresponding to the care of premature births. In addition, hospitals were ranked according to their unadjusted and adjusted rates, and we assessed the degree of concordance between these rankings. Finally, the correlations of hospital-adjusted adverse outcomes were also tested. METHODS: The study utilized the 5-year Taiwan Premature Infant Follow-up Network (TPFN) database in Taiwan from 2014 to 2018, and the sample size was 6482. We calculated the "observed over expected" (OE) ratio every year to form the risk-adjusted adverse outcome rate for each hospital. RESULTS: There was a larger variation in the risk-adjusted rate for NEC and the second-largest variation for IVH. Regarding the concordances between the unadjusted and adjusted ranks, the ranks for mortality had the lowest concordance (coefficient of concordance 0.64), and only a few of the risk-adjusted rates between outcomes were significantly correlated. CONCLUSION: The results of the TPFN show that there is room to improve performance in terms of large variations in NEC and IVH. Furthermore, risk adjustment is important, especially for mortality, since the ranks for mortality have the lowest concordance. Finally, we cannot generate a conclusion regarding whether a hospital is high in quality if we only take 1 or 2 adverse outcomes as profiling measures because only a few of the risk-adjusted rates between outcomes were significantly correlated.

The gestational effect of antenatal corticosteroids on respiratory distress syndrome in very low birth weight infants: A population-based study.

BACKGROUND/PURPOSE: The aim of this study was to evaluate the efficacy of antenatal corticosteroids for preventing very low birth weight (VLBW) infants with respiratory distress syndrome (RDS) from surfactant use at different gestational ages (GA). METHODS: We retrospectively analyzed the VLBW preterm infants registered in the Premature Baby Foundation of Taiwan from 1997 through 2014. Infants at 20-37 weeks' gestation were included, and infants with lethal congenital anomaly, chromosomal anomaly, and congenital infection were excluded. Antenatal corticosteroid courses were classified into two groups (<2 doses or ≧2 doses). The beneficial effect of antenatal corticosteroids on preventing VLBW infants with RDS from surfactant use was evaluated according to gestational ages. RESULTS: Total 12,685 VLBW infants were included. For VLBW infants with gestational age 26-33 weeks, antenatal corticosteroid therapy has significantly protective effect (odds ratio 0.43 [95% CI 0.26 to 0.72] - 0.60 [95% CI 0.48 to 0.75], P < 0.05). The effect was not obvious for VLBW infants with gestational age 34 weeks and more (odds ratio 0.32 [95% CI 0.08 to 1.38], P = 0.127). CONCLUSION: For VLBW infants with RDS at 34 weeks' gestation and more, the beneficial effect of antenatal corticosteroids on preventing surfactant use was not evident. In conclusion, completion of two doses or more of antenatal corticosteroids is of great importance for VLBW infants with RDS at gestational age between 26 and 33 weeks on preventing surfactant use.

Outcomes and related factors in a cohort of infants born in Taiwan over a period of five years (2007-2011) with borderline viability.

BACKGROUND: Advances in perinatal and neonatal care have increased the survival of extremely preterm infants, but the viability limit is still debated. Here we assess the survival, neonatal morbidity, and neurodevelopmental outcomes at 2 years of age of infants born at 22-26 weeks of gestation in Taiwan between 2007 and 2011. METHODS: This is a prospective longitudinal multicenter cohort study on extremely preterm infants registered in the Taiwan Premature Infant Developmental Collaborative Study Group from 2007 to 2011, including 22 neonatal care centers. We extracted demographic and clinical data of infants born at 22-26 weeks, and obtained growth and developmental outcome data from the follow-up clinic at 24 months of corrected age. Multivariate analyses using a logistic regression model identified factors significantly impacting survival. RESULTS: 647 of the 1098 infants included in the study (58.9%) survived to discharge. Survival rates were 8% (4/50), 25% (27/108), 46.8% (117/250), 67.0% (211/315), and 76.8% (288/375) for infants born at 22, 23, 24, 25, and 26 weeks, respectively. Most survivors (567/647, 87.6%) had major morbidities during hospitalization, and we identified factors that positively and negatively affected survival. 514 (79.4%) patients received follow-up evaluation at 2 years, and 204 (39.7%) of them had neurodevelopmental impairment (NDI) with an incidence of 75%, 65.2%, 49.5%, 39.5%, and 32.8% for infants born at 22, 23, 24, 25, and 26 weeks, respectively. CONCLUSION: Infants born at 22 and 23 weeks have a very low likelihood of surviving with little or no impairment. These findings are valuable for parental counseling and perinatal care decisions.

Morbidity and mortality of very low birth weight infants in Taiwan-Changes in 15 years: A population based study.

BACKGROUND/PURPOSE: Very low birth weight (VLBW) infants account for over 50% of perinatal deaths in Taiwan. This study aimed to identify changes in parental characteristics, perinatal conditions, mortality, and major neonatal morbidities for VLBW infants in Taiwan, and to highlight the challenges faced by patients, families, and caregivers. METHODS: We conducted a retrospective cohort study to investigate the mortality and morbidity of VLBW infants registered in the Taiwan Premature Infant Follow-up Network from 1997 through 2011. The exclusion criteria included congenital anomalies and chromosome anomalies. Continuous data was represented as mean ± SD, and changes over time in the variables were tested using one-way analysis of variance, with p < 0.05 considered statistically significant. RESULTS: A total of 13,159 VLBW infants were enrolled. We found significant increases over time in the parental age and educational level, in vitro fertilization, first livebirth, multiple births, maternal transfer, cesarean section, and complete antenatal steroid use. Apgar scores at 1 minute and 5 minutes after birth increased, and the intubation rate decreased gradually. Decreasing mortality over time for each successive period was demonstrated. Incidence of some morbidities increased, such as respiratory distress syndrome and patent ductus arteriosus; in contrast, incidence of others decreased, such as sepsis, necrotizing enterocolitis, intraventricular hemorrhage, and chronic lung disease. However, retinopathy of prematurity (ROP) incidence remained constant. CONCLUSION: Although the mortality and most of the morbidity of VLBW infants improved over time, the incidence of ROP remained constant. This requires us to further evaluate our strategy for preventing ROP in the future.

Is medical students' moral orientation changeable after preclinical medical education?

PURPOSE: Moral orientation can affect ethical decision-making. Very few studies have focused on whether medical education can change the moral orientation of the students. The purpose of the present study was to document the types of moral orientation exhibited by medical students, and to study if their moral orientation was changed after preclinical education. METHODS: From 2007 to 2009, the Mojac scale was used to measure the moral orientation of Taiwan medical students. The students included 271 first-year and 109 third-year students. They were rated as a communitarian, dual, or libertarian group and followed for 2 years to monitor the changes in their Mojac scores. RESULTS: In both first and third-year students, the dual group after 2 years of preclinical medical education did not show any significant change. In the libertarian group, first and third-year students showed a statistically significant increase from a score of 99.4 and 101.3 to 103.0 and 105.7, respectively. In the communitarian group, first and third-year students showed a significant decline from 122.8 and 126.1 to 116.0 and 121.5, respectively. CONCLUSION: During the preclinical medical education years, students with communitarian orientation and libertarian orientation had changed in their moral orientation to become closer to dual orientation. These findings provide valuable hints to medical educators regarding bioethics education and the selection criteria of medical students for admission.

Congenital midline nasal mass: cases series and review of the literature.

Encephalocele, glioma and dermoid cyst are the most common midline nasal masses. Given their potential for intracranial extension, prompt treatment is necessary to prevent complications. Herein, we present two cases of midline nasal masses. A comparison was made to delineate the differences between their clinical courses, treatments and outcomes. Case 1 was a baby girl with respiratory distress beginning at birth. Nasal glioma without definite intracranial extension was present. The mass was completely excised with the aid of a video-assisted endoscope without complications. At follow-up two years after surgery, no recurrence was noted. Case 2 was a two-year-old boy with a midline nasal dermoid cyst. Extirpation of the lesion through a vertical-dorsal approach was performed. He was discharged three days after surgery with a satisfactory aesthetic result.

Association of Maternal Preeclampsia with Neonatal Respiratory Distress Syndrome in Very-Low-Birth-Weight Infants.

Preeclampsia is a common cause of preterm birth and neonatal morbidity, but its relationship with neonatal respiratory distress syndrome (RDS) remains controversial. We conducted a retrospective cohort study with data from very-low-birth-weight (VLBW) infants born in 1997-2014 from the database of the Premature Baby Foundation of Taiwan to evaluate the relationship between maternal preeclampsia and neonatal RDS. In total, 13,490 VLBW infants were enrolled, including 2200 (16.3%) infants born to preeclamptic mothers. The mean (standard deviation) gestational ages were 30.7 (2.5) weeks in the preeclamptic group and 28.6 (2.9) weeks in the control (non-preeclamptic) group. Severe RDS was defined according to the surfactant therapy requirement. The incidence of severe RDS was lower in infants exposed to maternal preeclampsia than in controls [28.9% vs. 44%; odds ratio (OR), 0.52; 95% confidence interval (CI), 0.47-0.57]. However, after adjustment for confounders, the OR for severe RDS development in the preeclampsia group was 1.16 (95% CI, 1.02-1.31). Other factors, such as gestational age, birth weight, female sex, and antenatal receipt of two or more steroid doses were significantly protective against RDS in multivariate regression analysis. This study revealed that maternal preeclampsia slightly increases the risk of severe RDS in VLBW infants.

Cognitive development at age 8 years in very low birth weight children in Taiwan.

BACKGROUND/PURPOSE: All children should have some developmental screening periodically throughout childhood, especially those who were born prematurely. There is limited information about the development of children with very low birth weight (VLBW; birth weight < 1500 g) beyond the preschool age in Taiwan. We evaluated intelligence quotient (IQ) and cognitive ability of prematurely born school-aged children in Taiwan. METHODS: This was a multicenter study of VLBW and full-term children born between 1995 and 1997 at four hospitals in northern Taiwan. We used the Wechsler Intelligence Scale for Children, 3rd Edition (WISC-III), to assess these children. Demographic data were recorded including maternal and paternal age, education, birth weight, gestational age, and gender. RESULTS: A total of 189 children (130 with VLBW born prematurely and 59 born at full term) were recruited. There were significant differences in performance IQ (PIQ; 90.16 +/- 17.05 vs. 108.51 +/- 15.65, p < 0.001), verbal IQ (VIQ; 97.43 +/- 15.62 vs. 111.78 +/- 13.65, p < 0.001), full-scale IQ (FSIQ; 93.14 +/- 16.33 vs. 111.05 +/- 14.81, p < 0.001), verbal comprehension index score (VCIS; 98.06 +/- 15.53 vs. 112.47 +/- 13.74, p < 0.001), perceptional organization index score (POIS; 92.39 +/- 17.13 vs. 109.42 +/- 14.87, p < 0.001) and freedom from distractibility index score (FDIS; 98.34 +/- 17.71 vs. 110.53 +/- 10.94, p = 0.008). There was no correlation between perinatal outcomes and FSIQ. CONCLUSION: Our results suggest that VLBW children have significantly lower PIQ, VIQ, FSIQ, VCIS, POIS and FDIS at primary school compared with full-term children.

Factors affecting the non-compliance for follow-up in very low birth weight children.

BACKGROUND: Long-term longitudinal follow up of very low birth weight (VLBW, birth weight < or =1500 g) infants is important. This study assessed the factors affecting non-compliance for follow-up at different ages in VLBW children. METHODS: The demographic data, morbidity and neurodevelopmental data of 321 VLBW infants were analyzed between those returned and not returned. RESULTS: The majority of the children who did not attend the follow-up clinic were caused by inaccessibility, and refusal by the parents. The non-compliant children had higher rate of multiple births, short paternal education years, mother being a housewife, and lower incidence of first child, emergent caesarian section and small for gestational age. They did not differ much from the children returned in the occurrence of neonatal diseases. No significant difference of the growth and neurodevelopmental status at the previous visit could be observed between children of the two groups. When data of different follow-up visits were compared, it was noted that the most common reason for not attending the follow-up visits was inaccessibility for the 6- and 12-month visits and refusal by the parents for other visits. Multivariate logistic regression analysis revealed that variable(s) increasing the non-compliance were none for the 6-month visit, severe retinopathy of prematurity for the 12-month visit, short duration of paternal education for the 18-, 24- and 36-month visits and multiple births for the 36-month visit. CONCLUSIONS: These results showed that the reasons and the affecting variables for not attending the follow-up assessment were different for different age groups.

The impact of small-for-gestational-age on neonatal outcome among very-low-birth-weight infants.

BACKGROUND: This study aimed to evaluate the impact of small-for-gestational-age (SGA) on mortality and morbidity in very-low-birth-weight (VLBW) infants. METHODS: We conducted a retrospective cohort study on VLBW infants registered at the Premature Baby Foundation of Taiwan between 2007 and 2011. All 21 neonatal departments in Taiwan participated in the data collection, and a total of 4636 VLBW infants were registered during the study period. The SGA group (n = 560) was selected from the database on the basis of birth weight below the 10(th) percentile for gestational age, whereas the appropriate-weight-for-gestational-age (AGA) group (n = 1120) included infants randomly selected via incidence density sampling with a 2:1 match for each SGA case. The association of SGA with individual outcome variables including mortality, respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity (ROP), intraventricular hemorrhage, periventricular leukomalacia, and bronchopulmonary dysplasia (BPD) was evaluated after adjustment for potential confounders. RESULTS: The SGA group was associated with increased risks of mortality [odds ratio (OR) 1.89; 95% confidence interval (CI) 1.39‒2.58], severe ROP (OR 1.56; 95% CI 1.13-2.14), and BPD (OR 2.08; 95% CI 1.58-2.75) compared to the AGA group. Further subgroup analysis showed that SGA had significant effects on mortality in the VLBW infants with a gestational age of 24-29 weeks, as well as on BPD in those with a gestational age of 27-32 weeks. By contrast, the association of SGA with severe ROP was only significant in the VLBW infants with a gestational age of 27-29 weeks. CONCLUSION: Our data provide evidence that SGA may be associated with increased risks of neonatal mortality, ROP, and BPD in VLBW infants.

Preeclampsia and Retinopathy of Prematurity in Very-Low-Birth-Weight Infants: A Population-Based Study.

Preeclampsia and retinopathy of prematurity (ROP) are associated with impaired angiogenesis. Previous studies on the relationship between preeclampsia and ROP have produced conflicting results. The goal of this study was to evaluate the association between maternal preeclampsia and ROP using a large population-based cohort of very-low-birth-weight (VLBW) infants from 21 neonatal departments registered in the database of the Premature Baby Foundation of Taiwan. Multivariable logistic regression analysis was used to estimate the adjusted odds ratios (OR) and 95% confidence intervals (CI) for preeclampsia with reference to ROP and severe ROP. A total of 5,718 VLBW infants (844 cases with maternal preeclampsia) were included for analysis. The overall incidences of mild and severe ROP were 36.0% and 12.2%, respectively. Univariable analysis showed lower GA and lower birth weight, vaginal delivery, non-SGA, RDS, PDA, sepsis, transfusion, and absence of maternal preeclampsia to be associated with mild and severe ROP development. However, OR (95% CI) adjusted for the variables that were significant according to univariable analysis showed the risks of developing any-stage ROP and severe ROP for maternal preeclampsia to be 1.00 (0.84-1.20) and 0.89 (0.63-1.25), respectively. The results remained unchanged in stratified analyses according to SGA status. Our data showed that maternal preeclampsia was not associated with the subsequent development of any stage or severe ROP in VLBW infants.

Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit.

OBJECTIVE: To evaluate the effects of a hand hygiene program on compliance with hand hygiene and the rate of nosocomial infections in a neonatal intensive care unit (NICU). DESIGN: Open trial. SETTING: A level-III NICU in a teaching hospital. PARTICIPANTS: Nurses, physicians, and other healthcare workers in the NICU. INTERVENTIONS: A multimodal campaign for hand hygiene promotion was conducted beginning in September 1998. This program consisted of formal lectures, written instructions and posted reminders regarding hand hygiene and proper handwashing techniques, covert observation, financial incentives, and regular group feedback on compliance. Surveillance of handwashing compliance and nosocomial infections before and during the program was analyzed. RESULTS: Overall compliance with hand hygiene improved from 43% at baseline to 80% during the promotion program. The rate of nosocomial infections decreased from 15.13 to 10.69 per 1,000 patient-days (P = .003) with improved handwashing compliance. In particular, respiratory tract infections decreased from 3.35 to 1.06 per 1,000 patient-days during the handwashing campaign (P = .002). Furthermore, the correlation between nosocomial infection of the respiratory tract and handwashing compliance also reached statistical significance (r = -0.385; P = .014). CONCLUSIONS: Improved compliance with handwashing was associated with a significant decrease in overall rates of nosocomial infection and respiratory infections in particular. Washing hands is a simple, economical, and effective method for preventing nosocomial infections in the NICU.

Bilateral central retinal vein occlusion with multiple intracerebral hemorrhage in a neonate.

Central retinal vein occlusion and intracerebral hemorrhage are rare diseases during infancy and are both related to venous thrombosis. We present the case of a full-term male hydrops infant without specific neurologic symptoms initially but later demonstrating bilateral central retinal vein occlusion and intracerebral hemorrhage. We conclude that routine funduscopic examination in high-risk newborns should be seriously considered.

Outcome of very low birth weight infants with sonographic enlarged occipital horn.

The objective of this study is to compare the neurodevelopmental outcome between very low birth weight infants with and without sonographic disproportionate enlargement of occipital horn. We retrospectively reviewed the brain sonography of all very low birth weight infants born at National Taiwan University Hospital between June 1997 and June 1999. Brain sonography was routinely performed at the age of the third, seventh, twenty-first, and later days as clinically indicated. Intracranial hemorrhage, periventricular leukomalacia, congenital hydrocephalus, and Stage III retinopathy of prematurity were excluded from our study because of the association with neurodevelopmental impairment. Patients with disproportional dilatation of occipital horn more than 15 mm in width were included in the study group, and those with less than 15 mm were in the control group. Both groups received developmental evaluation by the Bayley Scales of Infant Development II at corrected age of 6, 12, 18, and 24 months, respectively. Socioeconomic status and detailed medical history were obtained at assessments. Independent-samples t test was used for comparison. A total of 81 very low birth weight infants were included in this study: 49 infants (female 18, male 31) in the study group and 32 infants (female 23, male 9) in the control group. The mean gestation in these two groups was 30 +/- 2 weeks and 31.1 +/- 2.2 weeks (P = 0.156), and the mean birth body weight was 1290 +/- 269 gm and 1282 +/- 219 gm (P = 0.877), respectively. At corrected age of 24 months, there was no significant difference in muscle tone, neuromotor impairment, hearing impairment, vision, or speech development. Assessment with the mental development index (88.9 +/- 15.6 vs 93 +/- 13.2) (P = 0.238) and the psychomotor development index (93.3 +/- 10.3 vs 89.6 +/- 12.1) (P = 0.149) between these two groups was also comparable. This retrospective analysis suggests that ultrasonographic disproportionate enlargement of the occipital horn in very low birth weight infants does not affect the neuromotor development at corrected ages of 6, 12, 18, and 24 months.

Delivery before 32 weeks of gestation for maternal pre-eclampsia: neonatal outcome and 2-year developmental outcome.

BACKGROUND AND OBJECTIVE: In the literature, there are conflicting data on the neonatal outcome in preterm infants who were delivered for maternal pre-eclampsia. The purpose of this study is to investigate the effect of maternal pre-eclampsia on neonatal morbidity and 2-year developmental outcome in a population of preterm infants delivered before 32 weeks of gestation. METHODS: The hospital records of all 89 surviving VLBW infants with GA below 32 weeks born from January 1997 to December 1999 were reviewed retrospectively. Data on respiratory outcome, sepsis and intraventricular hemorrhage (IVH) were compiled and analyzed for their association to maternal pre-eclampsia. Seventy-eight infants were assessed employing the Bayley Scales of Infant Development for developmental outcome at 2 years of corrected age. RESULTS: There was no difference in neonatal morbidity between groups. More infants born to pre-eclamptic mothers had lower MDI scores at 24 months of age (P=0.04) as compared to infants without maternal pre-eclampsia. After multiple logistic regression analysis, pre-eclampsia (P=0.007, OR=10.8) remained a significant risk factor of mildly delayed MDI at 24 months of age. CONCLUSION: Delivery before 32 weeks because of pre-eclampsia was associated with an increased risk of poor cognitive outcome. There was no significant difference in the postnatal course in comparison with infants born after pregnancies not complicated by pre-eclampsia.

Rehospitalization of extremely-low-birth-weight infants in first 2 years of life.

AIMS: To determine whether (1) chronic lung disease (CLD) is the prime reason for extremely-low-birth-weight (ELBW) infant readmission during the first 2 years of life, (2) surfactant and other advanced therapies have reduced ELBW infant readmissions, (3) home oxygen therapy (HOT) is efficacious for this group. STUDY DESIGN: The hospital records of these ELBW infants were reviewed retrospectively. Data on age, diagnosis, treatment, and duration of each hospitalization were compiled and analyzed for their association to CLD and to readmission for CLD and other reasons. SUBJECTS: All 60 surviving infants with a birth body weight of less than 1001 g (ELBW) born from January 1993 to February 1998 were followed up to 2 years (mean 20.4 +/- 7.4 months) to evaluate their respiratory outcome. RESULTS: Forty-two percent of these infants developed CLD. Upon discharge from the hospital, 28% (7/25) of the patients were given HOT for a median period of 60 days. Of the 47 ELBW infants who were studied the entire 2-year period, 72% were readmitted. Infants with CLD were readmitted more frequently (p=0.045) and had longer hospital stays during the first 2 years of life (p=0.034) than those without CLD. Respiratory illness was the main reason for readmission (55%) of these ELBW infants. The incidence of readmission due to respiratory tract infection was not significantly different in infants with CLD (61%) and infants without respiratory complications (44%) (p=0.159). CONCLUSIONS: Infants with CLD (whether receiving HOT or not) showed no higher readmission rate due to respiratory infection, but the HOT group did have higher morbidity. The premature lung itself rather than the presence of CLD, as we would expect, makes ELBW infants more prone to readmission for respiratory illness.

Relationship between spontaneous kicking and age of walking attainment in preterm infants with very low birth weight and full-term infants.

BACKGROUND AND PURPOSES: Although early kicking differences have been reported for preterm infants without overt cranial sonographic abnormalities, their functional importance remains unclear because no outcomes have been measured. Therefore, the first purpose of this prospective study was to examine the age of walking attainment in preterm infants who had very low birth weight (VLBW) but no overt neurosonographic abnormalities and full-term infants without known impairments or pathology. The second purpose was to examine the relationship between spontaneous kicking and age of walking attainment in these infants. SUBJECTS AND METHODS: Twenty-two preterm infants and 22 full-term infants were examined for kicking movements at 2 and 4 months corrected age and were followed up for age of walking attainment until 18 months corrected age. RESULTS: Survival analysis showed that infants with VLBW attained walking ability at older ages than full-term infants after correction for prematurity. Cox proportional-hazards regression analyses for all infants revealed that a high hip-knee correlation at 2 months corrected age, a high kick frequency at 4 months corrected age, and a short intra-kick pause together with a low variability in interlimb coordination at 2 and 4 months corrected age were all associated with a decreased rate of walking attainment. DISCUSSION AND CONCLUSION: The results indicated that preterm infants who had VLBW but no overt neurosonographic abnormalities had an increased risk of delayed walking attainment compared with full-term infants. Alterations of spontaneous kicking may predict a decreased rate of walking attainment in both preterm and full-term infants.

Developmental function of very-low-birth-weight infants and full-term infants in early childhood.

BACKGROUND AND PURPOSE: Despite general recognition that surviving very-low-birth-weight (VLBW) infants are at risk for neurodevelopmental impairments and educational achievement difficulties, there has been relatively little study on their functional status in areas such as locomotion, communication, cognition, self-care, and interpersonal relationships. This study assessed the functional status of VLBW infants and full-term infants in early childhood, and sought to identify risk factors for functional morbidity. METHODS: A total of 238 VLBW infants and 91 full-term infants were included in this prospective follow-up study. The functional status of the infants was assessed using the Chinese Child Development Inventory (CCDI) and neurodevelopment was evaluated using the Bayley Scales of Infant Development, second version (BSID-II) at 3 years of corrected age. Perinatal and sociodemographic data were collected through review of medical records. RESULTS: The VLBW infants had lower scores on all the CCDI measures compared with the full-term infants. Functional limitation (defined as more than 2 standard deviations below the means of the full-term infants) occurred more frequently in the VLBW infants than in the full-term infants: gross motor, 23% vs 3%; fine motor, 12% vs 1%; expressive language, 21% vs 2%; comprehension-conceptual, 23% vs 4%; situation comprehension, 17% vs 4%; self-help, 17% vs 1%; and personal-social, 19% vs 3% (all p < 0.01). Significant risk factors associated with functional morbidity included gestational age < 30 weeks, grade III-IV intraventricular hemorrhage, chronic lung disease, stage III-IV retinopathy of prematurity, male gender, and maternal education below high school. CONCLUSION: VLBW infants have a higher risk of functional morbidity than their full-term counterparts in early childhood. Infants with functional limitations on CCDI screening might require comprehensive developmental assessment and continued follow-up.

Neonatal outcome of infants born after in vitro fertilization at National Taiwan University Hospital.

BACKGROUND AND PURPOSE: This study compared the neonatal outcome between infants born after in vitro fertilization (IVF) and after natural conception at National Taiwan University Hospital. METHODS: All medical records of women who underwent IVF and gave birth at our hospital from January 1995 to December 1996 were reviewed. The charts of their offspring were also reviewed. We compared the neonatal outcome of infants born after IVF with that of infants born after natural conception. Neonatal outcome was evaluated based on preterm birth, very low birth weight (VLBW), perinatal morbidity, and neonatal mortality. RESULTS: A total of 75 women underwent IVF and gave birth to a total of 100 live newborns and two fetuses with intrauterine death during the 2-year study period. Among these newborns, the prevalence of preterm birth was 28%, of perinatal morbidity was 17%, and of neonatal mortality was 3%, which were significantly higher than those among the 7,736 neonates born after natural conception. However, the rate of VLBW was similar between the two groups. The rate of preterm birth for twin pregnancies were higher than that for singleton pregnancies in both groups. CONCLUSION: This study showed that infants born after IVF had a higher risk of preterm birth and higher perinatal morbidity and neonatal mortality.