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Objective. To determine changes in peri- and neonatal care concerning neonatal mortality and morbidity by comparing 2 cohorts of very prematurely born infants (gestational age [GA] Methods. The Leiden Follow-Up Project on Prematurity (LFUPP-1996/97), a regional, prospective study, includes all infants who were born alive after a GA Results. The absolute number of preterm births in the study region increased by 30%: 102 in 1983 to on average of 133 in 1996-1997. Centralization of perinatal care improved: the percentage of extrauterinely transported infants decreased from 61% in 1983 to 35% in 1996-1997. A total of 182 (73%) of the LFUPP-1996/97 infants were treated antenatally with glucocorticosteroids compared with 6 (6%) of the POPS-1983 infants. A total of 112 (42%) of the LFUPP-1996/97 infants received surfactant. In-hospital mortality decreased from 30% in the 1980s to 11% in the 1990s. Mortality of the extremely preterm infants ( Conclusions. An increase in the absolute number of very preterm births in this study region was found, leading to a greater burden on the regional NICUs. Improvements in peri- and neonatal care have led to an increased survival of especially extremely preterm infants. However, increased survival has resulted in more morbidity, mainly bronchopulmonary dysplasia, at the moment of discharge from the hospital. Pediatrics 2005;115:396-405; changes in peri- and neonatal care, time trend., ABBREVIATIONS. LFUPP, Leiden Follow-up Project on Prematurity; POPS, Project on Preterm and Small for Gestational Age Infants; GA, gestational age; SGA, small for gestational age; RDS, respiratory distress syndrome; BPD, [...]

Objective. To determine the outcome of infants with a gestational age (GA) Design. Regional, prospective study; part of the Leiden Follow-Up Project on Prematurity. Setting. Three health regions in The Netherlands. Patients. A total of 266 live born infants (1996/1997) with GA Main outcome measures. Neurologic examination (according to Hempel) and assessment of mental and psychomotor development using the Bayley Scales of Infant Development I, at the corrected age of 2 years. Results. Mortality was 35% (16 of 46) Conclusions. Mortality and neonatal morbidity were higher in infants with GA extremely premature infants, mortality, neonatal morbidity, neurologic outcome, psychomotor and mental development, behavior., ABBREVIATIONS. GA, gestational age; BPD, bronchopulmonary dysplasia; BSID, Bayley Scales of Infant Development; DA, definitely abnormal; IVH, intraventricular hemorrhage; LFUPP, Leiden Follow-Up Project on Prematurity; MA, mildly abnormal; MDI, mental [...]

The collaborative national survey on morbidity and mortality in preterm and small for gestational age infants in the Netherlands enrolled initially 1338 infants born in 1983. The relationship between maximal serum total bilirubin concentration in the neonatal period and neurodevelopmental outcome in the survivors of this cohort was studied. This relationship at the corrected age of 2 years was previously reported. A dose-response relationship between maximal serum total bilirubin concentration and risk of adverse outcome was observed in the 831 surviving children. The present study reassessed the relationship at the age of 5 years in 814 children. There was no significant difference in mean maximal serum total bilirubin concentration between the children with and without a handicap. This was confirmed by logistic regression analysis. After correction for seven suspected confounding factors (gestational age, birth weight, intracranial hemorrhage, ventriculomegaly, seizures, bronchopulmonary dysplasia, and socioeconomic status) the estimated odds ratio was 1.2 (confidence interval 0.89, 1.43) per 50 [mu]mo1/L increase of total bilirubin However, in this analysis an interaction between bilirubin and intracranial hemorrhage was observed. Therefore, the cohort was divided into two groups according to the absence or presence of an intracranial hemorrhage. Logistic regression analysis including four suspected confounding factors (gestational age, ventriculomegaly, seizures, and socioeconomic status) was then again applied. In children who had suffered from an intracranial hemorrhage in the neonatal period the estimated odds ratio was 1.84 (confidence interval 1.08, 3.15) per 50 [mu]mol/L increase of bilirubin. Similar results were obtained treating bilirubin as a categorized exposure. The odds ratio in children without a hemorrhage was 1.05 (confidence interval 0.80, 1.38), probably because of the small number of surviving handicapped children.

The relationship between peak serum bilirubin concentration while newborn and nerve development at age two years was studied. (Serum is the clear fluid component of blood; bilirubin is a pigment of bile). Initially, 1,400 infants born after less than 32 weeks or born weighing less than 1,500 grams were enrolled in the study; 145 were subsequently excluded because they were born malformed and 361 died during the study. At age two years, 830 children were available for follow-up. Children with handicaps due to nerve problems had experienced higher peak plasma bilirubin levels when newborn than children without nerve problems. The higher the peak serum bilirubin level, the worse the handicaps (mostly cerebral palsy). The risk of a handicap increased by 30 percent for each 50 micromole per liter increase in the peak serum bilirubin level. This suggests a causal relationship between the peak serum bilirubin level when newborn and problems of nerve development later on.