Neurodevelopmental outcome at age two years amongst very low birth weight infants: results from a district general hospital.

STUDY OBJECTIVES: To describe the survival and neurodevelopmental outcome at age 2 years of very low birth weight infants from routinely collected information in a district general hospital setting. DESIGN: Case note review and child health surveillance information was collected on all liveborn < 1,501 g infants born in our district general hospital over 4 years, 1989-1992. Main outcome measures were (a) death before discharge, (b) normal neurodevelopment at age 2 years, (c) minor impairment at age 2 years, (d) major impairment at age 2 years. Comparability with other published work was examined. SETTING: Rotherham District General Hospital, a maternity unit with neonatal intensive care facilities. Selected infants were transferred for continuing neonatal intensive care to a tertiary unit. Most infants were followed up to age 2 years in a dedicated clinic. SUBJECTS: Liveborn very low birth weight infants. MAIN RESULTS: Over the 4 year period there were 125 liveborn infants < 1,501 g; 93 (74%) survived to discharge home. Defined neurodevelopmental outcome measures were easily retrievable in 92 children at age 2 years from hospital case notes or child health surveillance records. Sixty-four children (70%) were neurodevelopmentally normal, 10 children (11%) had a major impairment (mostly cerebral palsy) and 18 (19%) had an isolated minor impairment. CONCLUSIONS: The incidence of major impairment amongst very low birth weight infants in our district general unit is broadly comparable with other published series. Outcome measures of neurodevelopmental status are available from routinely collected clinical information. The use of such measures to make detailed comparisons between units is problematical because of a wide range of confounding variables.

Early recognition of children with special educational needs: report from a district.

Health professionals involved in the pre-school child health surveillance programme need to identify those children who are likely to require a formal statement of special educational needs. Such children should be identified as early as possible, preferably by their fourth birthday. Each district needs to examine their programme and thereby identify factors associated with late recognition of such children. We report on our own practice and findings over a three-year period, including the factors associated with late recognition of special needs and efforts to improve the rate of early recognition.