- CI: confidence interval
- CLD: chronic lung disease
- ELGA: extremely low gestational age
- IVH: intraventricular hemorrhage
- MDI: Mental Development Index
- NICHD: National Institute of Child Health and Human Development
- NICU: neonatal intensive care unit
- PVL: periventricular leukomalacia
- ROP: retinopathy of prematurity
- SD: standard deviation
Drs Ho and Saigal did not disclose any relationships relevant to this article.
After completing this article, readers should be able to:
Describe the current survival and neonatal morbidity among infants of borderline viability.
Delineate the neurodevelopmental morbidity in the first 2 to 3 years after birth.
Appreciate the methodologic problems and difficulties in conducting and reviewing longitudinal studies on outcomes.
Explain how different perinatal management approaches affect outcomes.
Describe the impact of major neonatal morbidities on neurodevelopmental outcome.
Due to the combined efforts of obstetricians and neonatologists in optimizing perinatal and neonatal care, survival of infants at the threshold of viability has improved remarkably in the last decade. Neonatal intensive care is being offered to more and more immature infants. In addition, obstetricians appear to be more willing to intervene earlier due to the ability to perform more accurate assessments of gestational age, (1) the widespread use of antenatal corticosteroids (2) and postnatal surfactant, (3) and more heroic interventions such as cesarean delivery for a compromised fetus. (4)(5) This combination has resulted in an increase in the absolute number of survivors of extremely low gestational age (ELGA). At the same time, due to the high rates of disabilities in the face of increasing costs of providing neonatal intensive care, the debate continues over whether intensive care is justified for ELGA infants. (6)(7)(8) Thus, because of the rapid progress in both obstetric and neonatal care and the changing outcomes, it is vital to continue to evaluate the recent survivors. Fortunately, several recent publications address the early outcomes of regional cohorts of tiny infants based on reliable gestational age data. In addition, data are available on large cohorts from network studies around the world. Hack and Fanaroff (9) reviewed the outcomes of infants …