Management and outcomes of very low birth weight.

Copyright © 2008 Massachusetts Medical Society. Approximately 12.5% of births in the United States are preterm (occurring before 37 weeks of gestation). Preterm infants with “very low” birth weight are those who weigh 1500 g or less; those with “extremely low” birth weight weigh 1000 g or less. Although they account for only 1.5% and 0.7% of live births, respectively, these infants contribute disproportionately to neonatal morbidity and to health care costs. For example, in the United States approximately 40% of the estimated 6600 cases of cerebral palsy that are diagnosed each year occur in children with a very low birth weight.1 In 2003, preterm infants accounted for approximately $18.1 billion in health care costs, or half of total hospital charges, for newborn care in the United States.1 The often complicated medical outcomes in extremely premature infants have generated discussion of the ethics of investing medical and financial resources in those infants who are on the border of viability. This article reviews recent progress in the understanding, management, and outcomes of some of the most common conditions affecting infants with very low birth weight (Table 1). We emphasize the care of extremely-low-birth-weight infants and provide a perspective on the determinants of the long-term outcome.