The outcome at 12 months of very-low-birth-weight infants ventilated at Tygerberg Hospital.

OBJECTIVE To determine the outcome at 1 year of age of a group of very-low-birth-weight (VLBW) infants, from urban and rural communities, ventilated at Tygerberg Hospital, W. Cape. STUDY DESIGN Prospective descriptive study in which the prevalence of bronchopulmonary dysplasia (BPD), sensorineural deafness, intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP) and abnormal motor developmental outcomes were determined in 153 ventilated VLBW infants from rural and urban areas. Of these, 69% were from lower socio-economic backgrounds. MAIN OUTCOME MEASURES Attrition rates for rural and urban babies, BPD, ROP, IVH and abnormal motor development. STUDY POPULATION AND SETTING All ventilated VLBW infants discharged from the neonatal intensive care unit at Tygerberg Hospital over a 1-year period were followed up at 3-monthly intervals for 12 months. RESULTS BPD was diagnosed in 19% of the babies, with significantly more babies with birth weights under 1,000 g and gestational ages under 28 weeks having BPD. Of the babies with BPD, 25% had abnormal motor development at 1 year of age. Seven per cent of the babies had grade 3 or 4 ROP and 2.6% had sensorineural hearing loss. One hundred and seventeen (79%) of the infants attended the follow-up clinic until 12 months of age (corrected for prematurity). There were no significant differences in the number of babies followed up from rural or urban areas. Fourteen (11.9%) of the babies had abnormal motor development. A disturbing finding was that so many babies had spastic quadriplegia (8; 57%) versus diplegia (6; 43%). The incidence of abnormal motor development in the babies from the rural areas and in those with birth weights under 1,000 g from rural areas was high--a further cause for concern. CONCLUSION The prevalence of the major complications associated with ventilated VLBW infants correlated well with those reported for similar infants from First-World countries. The poor motor developmental outcome of the babies from rural areas with birth weights under 1,000 g and high attrition rates for infants with serious complications such as BPD, IVH and ROP are distressing.