NEUROSENSORY OUTCOME AT 5 YEARS AND EXTREMELY LOW-BIRTH-WEIGHT

Objective-To establish the stability of neurosensory outcome at 5 year s of age compared with 2 years of age, and to determine whether the im proving survival rate of extremely low birthweight (ELBW) (500-999 g) children has been accompanied by an increase in the number of severely impaired and disabled children in the community. Methods-A geographic ally determined cohort study was made of consecutive ELBW survivors bo rn in the state of Victoria during 1985-7, and during 1979-80, inclusi ve. Rates of neurosensory impairments and disabilities at 2 and 5 or m ore years of age were measured. Results-Of 212 children surviving to 5 years of age born during 1985-7, 211 (99.5%) had been assessed at 2 y ears of age, and 209 (98.6%) were assessed at 5 or more years of age. Of the 208 children seen at both 2 and 5 years, 32 children had deteri orated, 23 children had improved, and 153 were unchanged, compared wit h their 2 year assessment. The major reason for a change in classifica tion was an alteration in psychological test results. Compared with EL BW children born in 1979-80, those born in 1985-7 had significant redu ctions in hearing and intellectual impairment. The rate of severe neur osensory disability in the 1985-7 cohort was 5.7% compared with 12.4% in children born in 1979-80. Conclusions-The age of 2 is too early to be sure of neurosensory outcome in ELBW infants. The additional surviv ors born in the mid 1980s, compared with the late 1970s, are free of s evere neurosensory disability at 5 years of age, with no increase in t he absolute number of ELBW children surviving with severe neurosensory disability.