{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:03:40Z","timestamp":1791201820309,"version":"4.2.0"},"reference-count":48,"publisher":"American Academy of Pediatrics (AAP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,4,1]]},"abstract":"<jats:p>Background. Advances in perinatal care have resulted in increased survival rates for extremely low birth weight children. We sought to examine the relative changes in rates of survival and neurodevelopmental impairment at 20 months of corrected age among 500- to 999-g birth weight infants born at our perinatal center during 2 periods, before and after the introduction of surfactant therapy in 1990.<\/jats:p><jats:p>Methods. Four hundred ninety-six infants with birth weights of 500 to 999 g were born at our perinatal center during period I (1982\u20131989) (mean body weight: 762 g; mean gestational age: 25.8 weeks) and 682 during period II (1990\u20131998) (mean body weight: 756 g; mean gestational age: 25.5 weeks). Rates of death and survival with and without neurodevelopmental impairment at 20 months of corrected age for the 2 periods were compared with logistic regression analyses, with adjustment for gestational age.<\/jats:p><jats:p>Results. Survival rates increased from 49% during period I to 67% during period II. Neonatal morbidity rates also increased during period II, including rates of sepsis (from 37% to 51%), periventricular leukomalacia (from 2% to 7%), and chronic lung disease, defined as oxygen dependence at 36 weeks of corrected age (from 32% to 43%). Rates of severe cranial ultrasound abnormalities were similar (22% vs 22%). Among children monitored, the rate of neurologic abnormalities, including cerebral palsy, increased from 16% during period I to 25% during period II and the rate of deafness increased from 3% to 7%. The overall rate of neurodevelopmental impairment (major neurosensory abnormality and\/or Bayley Mental Developmental Index score of &amp;lt;70) increased from 26% to 36%. Compared with period I, in period II there were decreased rates of death (odds ratio [OR]: 0.3; 95% confidence interval [CI]: 0.2\u20130.4) and increased rates of survival with impairment (OR: 2.3; 95% CI: 1.7\u20133.3) but also increased rates of survival without impairment (OR: 1.7; 95% CI: 1.3\u20132.2). Compared with period I, for every 100 infants with birth weights of 500 to 999 g born in period II, 18 additional infants survived, of whom 7 were unimpaired and 11 were impaired.<\/jats:p><jats:p>Conclusions. The improved survival rates in the 1990s occurred with an increased risk of significant neurodevelopmental impairment. Prospective parents of extremely low birth weight infants should be advised of this substantial risk, to facilitate decision-making in the delivery room.<\/jats:p>","DOI":"10.1542\/peds.2004-0221","type":"journal-article","created":{"date-parts":[[2005,4,1]],"date-time":"2005-04-01T18:03:40Z","timestamp":1112378620000},"page":"997-1003","source":"Crossref","is-referenced-by-count":532,"title":["Improved Survival Rates With Increased Neurodevelopmental Disability for Extremely Low Birth Weight Infants in the 1990s"],"prefix":"10.1542","volume":"115","author":[{"given":"Deanne","family":"Wilson-Costello","sequence":"first","affiliation":[{"name":"From the Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harriet","family":"Friedman","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nori","family":"Minich","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avroy A.","family":"Fanaroff","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Hack","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2005,4,1]]},"reference":[{"key":"2021120819263901900_R1","doi-asserted-by":"crossref","unstructured":"Horbar JD, Wright EC, Onstad L. Decreasing mortality associated with the introduction of surfactant therapy: an observational study of neonates weighing 601 to 1300 grams at birth. Pediatrics.\u20081993;92:191\u2013196","DOI":"10.1097\/00006254-199403000-00012"},{"key":"2021120819263901900_R2","doi-asserted-by":"crossref","unstructured":"Schwartz RM, Luby AM, Scanlon JW, Kellogg RJ. Effect of surfactant on morbidity, mortality, and resource use in newborn infants weighing 500 to 1500 grams. N Engl J Med.\u20081994;30:1476\u20131480","DOI":"10.1056\/NEJM199405263302102"},{"key":"2021120819263901900_R3","doi-asserted-by":"crossref","unstructured":"Allen MC, Donohoe PK, Dusman AE. The limit of viability: neonatal outcome of infants born at 22 to 25 weeks gestation. N Engl J Med.\u20081993;329:1597\u20131601","DOI":"10.1056\/NEJM199311253292201"},{"key":"2021120819263901900_R4","doi-asserted-by":"crossref","unstructured":"Lorenz JM. Treatment decisions for the extremely premature infant. J Pediatr.\u20082000;137:593\u2013595","DOI":"10.1067\/mpd.2000.110532"},{"key":"2021120819263901900_R5","doi-asserted-by":"crossref","unstructured":"de Leeuw R, Cuttini M, Nadai M, et al. Treatment choices for extremely preterm infants: an international perspective. J Pediatr.\u20082000;137:608\u2013615","DOI":"10.1067\/mpd.2000.109144"},{"key":"2021120819263901900_R6","doi-asserted-by":"crossref","unstructured":"Doroshow RW, Hodgman JE, Pomerance JJ, et al. Treatment decisions for newborns at the threshold of viability: an ethical dilemma. J Perinatol.\u20082000;20:379\u2013383","DOI":"10.1038\/sj.jp.7200010"},{"key":"2021120819263901900_R7","doi-asserted-by":"crossref","unstructured":"Wood NS, Marlow N, Costeloe K, et al. Neurologic and developmental disability after extremely preterm birth. N Engl J Med.\u20082000;343:378\u2013384","DOI":"10.1056\/NEJM200008103430601"},{"key":"2021120819263901900_R8","doi-asserted-by":"crossref","unstructured":"Sweet MP, Hodgman JE, Pena I, Barton L, Pavlova Z, Ramanathan R. Two year outcome of infants weighing 600 grams or less at birth and born 1994 through 1998. Obstet Gynecol.\u20082003;101:18\u201323","DOI":"10.1097\/00006250-200301000-00008"},{"key":"2021120819263901900_R9","doi-asserted-by":"crossref","unstructured":"Hack M, Fanaroff AA. Outcomes of children of extremely low birthweight and gestational age in the 1990's. Semin Neonatol.\u20082000;5:89\u2013106","DOI":"10.1053\/siny.1999.0001"},{"key":"2021120819263901900_R10","doi-asserted-by":"crossref","unstructured":"Fanaroff AA, Wright LL, Stevenson DK, et al. Very-low-birth-weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, May 1991 through December 1992. Am J Obstet Gynecol.\u20081995;173:1423\u20131431","DOI":"10.1016\/0002-9378(95)90628-2"},{"key":"2021120819263901900_R11","unstructured":"National Institutes of Health. Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consens Statement.\u20081994;12:1\u201324"},{"key":"2021120819263901900_R12","unstructured":"Fanaroff AA, Martin RJ, eds. Neonatal-Perinatal Medicine. 7th ed. Philadelphia, PA: WB Saunders; 2001"},{"key":"2021120819263901900_R13","unstructured":"American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2002"},{"key":"2021120819263901900_R14","doi-asserted-by":"crossref","unstructured":"Shennan AT, Dunn MJ, Ohlsson A, Lenox K. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics.\u20081988;82:527\u2013532","DOI":"10.1542\/peds.82.4.527"},{"key":"2021120819263901900_R15","doi-asserted-by":"crossref","unstructured":"Bell MJ, Ternberg JL, Feigin RD, et al. Neonatal necrotizing enterocolitis: therapeutic decisions based on clinical staging. Ann Surg.\u20081978;187:1\u20137","DOI":"10.1097\/00000658-197801000-00001"},{"key":"2021120819263901900_R16","doi-asserted-by":"crossref","unstructured":"Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhages: a study of infants with birthweights less than 1500 grams. J Pediatr.\u20081978;92:529\u2013534","DOI":"10.1016\/S0022-3476(78)80282-0"},{"key":"2021120819263901900_R17","unstructured":"Bayley N. Bayley Scales of Infant Development. New York, NY: The Psychological Corp; 1969"},{"key":"2021120819263901900_R18","unstructured":"Bayley N. Bayley Scales of Infant Development. 2nd ed. San Antonio, TX: The Psychological Corp; 1993"},{"key":"2021120819263901900_R19","doi-asserted-by":"crossref","unstructured":"Amiel-Tison C, Stewart AL. Follow-up studies in the first five years of life: a pervasive assessment of neurologic function. Arch Dis Child.\u20081989;64:496\u2013502","DOI":"10.1136\/adc.64.4_Spec_No.496"},{"key":"2021120819263901900_R20","doi-asserted-by":"crossref","unstructured":"Bax M. Terminology and classification of cerebral palsy. Dev Med Child Neurol.\u20081964;6:295\u2013297","DOI":"10.1111\/j.1469-8749.1964.tb10791.x"},{"key":"2021120819263901900_R21","doi-asserted-by":"crossref","unstructured":"Usher R, McLean F. Intrauterine growth of live-born Caucasian infants at sea level: standards obtained from measurements in 7 dimensions of infants born between 25 and 44 weeks of gestation. J Pediatr.\u20081969;72:901\u2013910","DOI":"10.1016\/S0022-3476(69)80224-6"},{"key":"2021120819263901900_R22","doi-asserted-by":"crossref","unstructured":"Chan K, Ohlsson A, Symes A, et al. Survival, morbidity and resource use of infants of 25 weeks gestational age or less. Am J Obstet Gynecol.\u20082001;185:220\u2013226","DOI":"10.1067\/mob.2001.115280"},{"key":"2021120819263901900_R23","doi-asserted-by":"crossref","unstructured":"McNamara JA. Laser treatment for retinopathy of prematurity. Curr Opin Ophthalmol.\u20081993;4:76\u201380","DOI":"10.1097\/00055735-199306000-00013"},{"key":"2021120819263901900_R24","doi-asserted-by":"crossref","unstructured":"Piecuch RE, Leonard CH, Cooper BA, Sehring SA. Outcome of extremely low birth weight infants (500 to 999 grams) over a 12 year period. Pediatrics.\u20081997;100:633\u2013639","DOI":"10.1542\/peds.100.4.633"},{"key":"2021120819263901900_R25","doi-asserted-by":"crossref","unstructured":"O'Shea TM, Klinepeter KL, Goldstein DJ, Jackson BW, Dillard RG. Survival and developmental disability in infants with birth weights of 501 to 800 grams, born between 1979 and 1994. Pediatrics.\u20081997;100:982\u2013986","DOI":"10.1542\/peds.100.6.982"},{"key":"2021120819263901900_R26","doi-asserted-by":"crossref","unstructured":"Harper RG, Rehman KU, Sia C, et al. Neonatal outcome of infants born at 500 to 800 grams from 1990 through 1998 in a tertiary care center. J Perinatol.\u20082002;22:555\u2013562","DOI":"10.1038\/sj.jp.7210789"},{"key":"2021120819263901900_R27","doi-asserted-by":"crossref","unstructured":"Victorian Infant Collaborative Study Group. Improved outcome into the 1990's for infants weighing 500\u2013999 g at birth. 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Arch Dis Child Fetal Neonatal Ed.\u20081998;78:F99\u2013F104","DOI":"10.1136\/fn.78.2.F99"},{"key":"2021120819263901900_R34","unstructured":"Doyle LW, Keir E, Kitchen WH, et al. Audiologic assessment of extremely low birth weight infants: a preliminary report. Pediatrics.\u20081992;90:744\u2013749"},{"key":"2021120819263901900_R35","doi-asserted-by":"crossref","unstructured":"Anderson PJ, Doyle LW, Victorian Infant Collaborative Study Group. Executive functioning in school-aged children who were born very preterm or with extremely low birth weight in the 1990's. Pediatrics.\u20082004;114:50\u201357","DOI":"10.1542\/peds.114.1.50"},{"key":"2021120819263901900_R36","doi-asserted-by":"crossref","unstructured":"Wilson-Costello D, Borawski-Clark E, Friedman H, Redline R, Fanaroff A, Hack M. Perinatal correlates of neurologic impairment among very low birthweight children. Pediatrics.\u20081998;102:315\u2013322","DOI":"10.1542\/peds.102.2.315"},{"key":"2021120819263901900_R37","doi-asserted-by":"crossref","unstructured":"Grether JK, Nelson KB, Emery ES, Cummins SK. Prenatal and perinatal factors and cerebral palsy in very low birth weight infants. J Pediatr.\u20081996;128:407\u2013414","DOI":"10.1016\/S0022-3476(96)70292-5"},{"key":"2021120819263901900_R38","doi-asserted-by":"crossref","unstructured":"Murphy DJ, Hope PL, Johnson A. Neonatal risk factors for cerebral palsy in very preterm babies: case-control study. BMJ.\u20081997;314:404\u2013408","DOI":"10.1136\/bmj.314.7078.404"},{"key":"2021120819263901900_R39","doi-asserted-by":"crossref","unstructured":"Barrington KJ. The adverse neurodevelopmental effects of postnatal steroids in the preterm infant: a systematic review of RCT's. Biomed Central Pediatr.\u20082001;1:1","DOI":"10.1186\/1471-2431-1-1"},{"key":"2021120819263901900_R40","doi-asserted-by":"crossref","unstructured":"Lorenz JM, Paneth N, Jetton JR, denOuden L, Tyson JE. Comparison of management strategies for extreme prematurity in New Jersey and the Netherlands: outcomes and resource expenditure. Pediatrics.\u20082001;108:1269\u20131274","DOI":"10.1542\/peds.108.6.1269"},{"key":"2021120819263901900_R41","doi-asserted-by":"crossref","unstructured":"Nelson KB, Ellenberg JH. Children who \u201coutgrew\u201d cerebral palsy. Pediatrics.\u20081982;69:529\u2013536","DOI":"10.1542\/peds.69.5.529"},{"key":"2021120819263901900_R42","doi-asserted-by":"crossref","unstructured":"Ment LR, Vohr B, Allen W, et al. Change in cognitive function over time in very low birth-weight infants. JAMA.\u20082003;289:705\u2013753","DOI":"10.1001\/jama.289.6.705"},{"key":"2021120819263901900_R43","doi-asserted-by":"crossref","unstructured":"McCormick MC, McCarton C, Brooks-Gunn J, Belt P, Gross RT. The infant health and development program: interim summary. Dev Behav Pediatr.\u20081998;19:359\u2013370","DOI":"10.1097\/00004703-199810000-00009"},{"key":"2021120819263901900_R44","unstructured":"Hack M, Morrow M, Carter L, et al. Improved cognitive function of extremely-low-birth-weight children at age 8 years: poor predictive validity of the Bayley II Mental Developmental Index (MDI). Pediatr Res.\u20082004;55:504A"},{"key":"2021120819263901900_R45","doi-asserted-by":"crossref","unstructured":"Tyson J. Evidence-based ethics and the care of premature infants. Future Child.\u20081995;5:197\u2013213","DOI":"10.2307\/1602515"},{"key":"2021120819263901900_R46","doi-asserted-by":"crossref","unstructured":"Streiner DL, Saigal S, Burrows E, Stoskopf B, Rosenbaum P. 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