Neuromotoric and Sensory Morbidity in Children of Birth Weight below 1,500 g as an Index ofQuality of Perinatal and Neonatal Care

Overview

The aim of the study was to obtained data on the incidence of severe neurosensory morbidity (NSM) in childrenof birth weight below 1,500 g at the age of two years, born in the Czech Republic in the period of 1997-2000.Groups and methods: The authors created two cohorts of children born in the years 1997-1998 and 1999-2000,respectively. The two period were compared from the following points of view of: a) number of children born aliveand dismissed and those examined at their two years of life; b) incidence of neonatal morbidity (RDS, BPD, IVHof 3rd and 4th degree, cPVL and ROP > 3rd degree), which was compared with data of the Vermont-OxfordNetwork (VON) from the 1999-2000 years; c) the incidence of selected forms of NSM, detected at two years of age(CPO, PMR, disorders of vision for ROP and hearing disorders).Results: The number of children of birth weight below 1,500 g (especially in the category below 1,000 g) bornalive and dismissed in 1997-2000 increased. A the same time the number of these children examined in their twoyears of life increased. The analysis of neonatal morbidity revealed a higher incidence of infections and cPVL ascompared with theVON data. The incidence of other forms of morbidity was similar or lower. Incidence of selectedforms of NSM in the years 1997-1998 was not different from 1999-2000. There was a higher incidence of CPO inboth categories (i.e. 1,000-1,499 and below 1,000 g) in comparison with the reference data. The incidence of PMR,visual disorders and hearing loss was comparable.Conclusion: There was a decrease of perinatal and neonatal mortality (to 4.4/1,000 births or 2.4/1,000 bornalive) in the years 1997-2000. Specific neonatalmortality of newborns below 1,500 g (without VVV) decreased from352‰ to 115‰. This is in contrast with the markedly higher incidence of CPO. The priority for perinatal andneonatal care in the Czech Republic remains to maintain low mortality and to decrease the incidence of CPO. Theway to decrease the incidence of CPO is a strict adherence to antenatal induction of lung maturity with corticoidsand the prevention of perinatally originated cerebral morbidity due to hypoxia and infection.

Key words:
quality of perinatal and neonatal care, children of birth weight up to 1,500 g, neuromotor andsensory morbidity