Outcomes for Extremely Low Birth Weight Infants
In an accompanying editorial, Jon E. Tyson, M.D., M.P.H., of the University of Texas Health Science Center and Houston Medical School, and Saroj Saigal, M.D., of McMaster University, Hamilton, Ontario, discuss the study by Hack et al.
"The current state-of-the-art in follow-up studies might be enhanced to increase their value and facilitate better outcomes for high-risk infants by considering the following strategies. First, follow-up assessments should be performed and reported for all survivors in the lowest gestational age categories as well as all those in the lowest birth-weight categories. ...Second, emphasis should be placed on performing population-based follow-up studies in the United States, as in other countries. Virtually all such studies have been performed outside the United States. ...Third, to help in addressing ethical dilemmas in the care of marginally viable infants, the mortality and long-term morbidity of these infants should be related to treatment decisions to forgo or withdraw intensive care."
"Fourth, quality of life should be assessed in long-term survivors. Despite systematically higher disability rates among ELBW vs. NBW survivors, Canadian studies have reported minimal difference in their self-assessed quality of life in adolescence and early adulthood. Whether this is true in U.S. populations is an important question. And fifth, the use of follow-up assessments should be expanded in testing interventions used before or after nursery discharge to reduce adverse medical, neurodevelopmental, or functional outcomes."
"Most of these strategies would entail considerably more effort and expense. However, the best possible follow-up studies are crucial to a clear understanding of the outcome of small premature infants, the beneficial or harmful effects of perinatal treatment decisions, and the long-term needs of these children for special medical or educational services," the authors write.