The likelihood of sustaining neurological, sensory or cognitive deficits is considerably greater for very low birthweight (VLBW) infants who require intensive care in early postnatal life than those without major neonatal illness. Identifying which, if any, medical events are responsible for an adverse outcome is most difficult in the face of multiple concurrent complications. In this research, a principal components analysis was performed in order to arrive at a set of orthogonal variables which succinctly described clinical involvement in the nursery. With this procedure, a single hypothetical factor depicting neonatal status (NS) was computed. Principal component scores were then generated for NS and assigned to 252 VLBW (less than 1500 g) infants. These subjects were followed prospectively from birth to 4 years of age. Standardized measures of neurological, sensory and intellectual function were regularly administered. Neonatal status was shown to be significantly correlated with the various test results and predictive of long-term development. When subjects were divided into quartiles with respect to NS, a specific subgroup was identified as "at high risk" for poor outcome. Those subjects falling into the lower quartile incurred more neurological abnormalities persisting beyond the first year. They also suffered a higher incidence of intracranial hemorrhage and sensori-neural hearing loss. In addition, the lower 25%, as a group, scored well below all others on traditional tests of mental ability. These differences were sustained throughout infancy and early childhood and could not be attributed to a number of demographic variables including sex, gestational age, birthweight, Apgar scores or parental educational level.

Child Development↗

PubMedDate not supplied

Mode of delivery in pregnancies complicated by preeclampsia with very low birth weight infants.

The aims of this study were to examine data from an institution at which the goal has been to pursue vaginal delivery in patients with a preterm gestation and preeclampsia and to test the hypothesis that labor does not increase the risk of poor outcome for the preterm infant of a mother with preeclampsia. An analysis of all singleton infants born live who weighed 1500 gm or less and who were born to mothers with preeclampsia or eclampsia from 1975 to 1990 was undertaken. The infants who were delivered by cesarean section without labor and with a reassuring fetal assessment were compared with the infants who went through labor. Of 116 women with singleton pregnancies with preeclampsia and an infant who weighed 1500 gm or less, 54.3% were delivered by cesarean section without labor, 31.0% because of nonreassuring fetal assessment and 23.3% (group 1) because of other indications. Of the patients allowed to labor (group 2), 47.2% had cesarean sections because of fetal intolerance of labor and 32.1% were delivered vaginally. Of the patients who were delivered vaginally, 75% had an unfavorable Bishop's score at the outset of the induction. There was no significant difference between groups 1 and 2 for a number of immediate and long-term outcome variables except for a lower incidence of respiratory distress syndrome in the infants who went through labor. On the basis of these limited data a trial of labor should be considered in carefully selected women with preeclampsia who have very-low-birth-weight infants.

Cesarean Section↗