Regional differences in outcome for very low-birthweight infants: Do they persist at 7-8 years of age?

Objective: To determine whether regional differences in early neonatal morb idity in a national cohort of very low-birthweight (VLBW) infants persisted at 7-8 years of age. Methods: Perinatal data collected prospectively from birth on all VLBW infa nts born in New Zealand in 1986 and admitted to a neonatal unit included th e hospital principally caring for the infant: hospitals A-D being level III hospitals and 'Other' including the smallest level III and all level II ho spitals. At 7-8 years of age, 298 surviving children (96% survivors living in New Zealand) were assessed at a home visit. Parents were given a compreh ensive questionnaire to complete, the children underwent a visual examinati on and were tested with the Revised Wechsler Intelligence Scale for Childre n and the child's teacher was sent a questionnaire to complete. Results: Neonatal survival was significantly greater in the two largest hos pitals (A and B) and this difference in survival remained at 7-8 years of a ge after adjustment for perinatal factors (P < 0.05). There were no differe nces between hospitals in risks of long-term sensorineural disability and b ehavioural or educational outcomes. There were interhospital differences in rates of visual problems and, after adjustment for confounding factors, th ere remained a marginally significant (P = 0.06) increased risk of myopia i n hospital D. Conclusions: Despite differences in early morbidity favouring larger hospit als, there were no substantive differences in long-term (7-8 years) outcome s across a range of measures in this national cohort of VLBW infants.