Outcome of extremely-low-birth-weight infants at highest risk: Gestational age ≤24 weeks, birth weight ≤750 g, and 1-minute Apgar ≤3

Objective The purpose of this study was to evaluate neurodevelopmental outcome in extremely-low-birth-weight (ELBW) infants, all of whom had 3 characteristics: gestational age (GA) ≤24 weeks, birth weight ≤750 g, and 1-minute Apgar score ≤3. Study design Surviving infants were evaluated at 18 to 22 monthsʹ corrected age with a neurologic examination and the Bayley II Mental and Psychomotor Developmental Index (MDI and PDI). Results Between 1993 and 1999, 1016 infants had GA ≤24 weeks, birth weight ≤750 g, and 1-minute Apgar score ≤3. Of 246 survivors, 30% had cerebral palsy (CP), 5% had hearing impairment, and 2% were blind. MDI was ≥85 in 33% and <70 in 46% of infants, while PDI was ≥85 in 41% and <70 in 36% infants. Predictors of MDI <70 were grade III-IV ICH, cystic periventricular leukomalacia (PVL), male gender, black race, and Medicaid insurance. Two-parent household was associated with an MDI >70. Predictors of PDI <70 were grade III-IV ICH, PVL, steroids for bronchopulmonary dysplasia (BPD), and Medicaid insurance. CP was associated with grade III-IV ICH and PVL. Conclusion Perinatologists and neonatologists should be aware of the risk of morbidity and mortality in this high-risk ELBW group.