Women born with very low birth weight have similar menstrual cycle pattern, pregnancy rates and hormone profiles compared with women born at term.

BACKGROUND: Individuals born very preterm or with very low birth weight (VLBW) have a reduced likelihood to reproduce according to population-based register studies. Extremely low-birth weight born adults had a lower reproduction rate for both men and women in a follow-up study. AIM: To investigate if being born with VLBW is associated with differences in the reproductive health, i.e. age of menarche, menstrual cycle pattern, pregnancy rates and hormone profile compared with women born at term. METHODS: A prospective long-term follow-up of a cohort of live-born VLBW children and their controls studied repeatedly since birth and now assessed at 26-28 years of age. Of the totally 80 girls enrolled from birth 49 women (24 VLBW women and 25 controls) participated in the current follow-up. The women's anthropometric data and serum hormone levels were analysed. RESULTS: The reproductive hormone levels, including Anti-Mullerian Hormone, did not differ significantly between VLBW women and their controls. Both groups reported menstrual cycle irregularities and pregnancies to the same extent but the VLBW women reported 1.5 years later age of menarche. The VLBW subjects had a catch-up growth within 18 months of birth but remained on average 5 cm shorter in adult height. There were no significant differences in BMI, sagittal abdominal diameter, blood pressure or in their answers regarding life style between the VLBW women and the controls. CONCLUSION: No differences in the reproductive hormone levels were found between VLBW women and their controls. Although age at menarche was somewhat higher in the VLBW group menstrual cycles and pregnancy rates were similar in the VLBW and control groups. Further follow-up studies are required to elucidate the health outcomes of being born VLBW.

A long-term follow-up study of men born with very low birth weight and their reproductive hormone profile.

Environmental factors during the fetal period may adversely affect reproductive functions in men being born with very low birth weight (VLBW, <1500 g). The objective of this prospective, controlled cohort study was to investigate if VLBW men have an altered reproductive hormone profile compared with men born at term. The study group initially consisted of all VLBW boys live-born between 1 February 1987 and 30 April 1988 in the south-east region of Sweden (n = 47). A control child was chosen born at term, at the same hospital, with the same parity, without malformations, and next in order after each VLBW child who survived the first four weeks (n = 45). The present follow-up was performed when the men were 26-28 years of age and included measurements of serum hormone levels, hair testosterone concentration, and anthropometric data. Also life-style questionnaires were collected from 26 VLBW men and 19 controls. The VLBW group (n = 26) had higher median levels of serum estradiol, 84.5 pmol/L than controls (n = 19), 57.5 pmol/L (p = 0.008). There was no significant correlation between serum estradiol and BMI (r = 0.06, p = 0.74). There were no differences in other hormone levels or the reproductive pattern between the groups. In conclusion, even though there was a statistically significant difference in estradiol levels between the groups, both groups had low normal mean levels of questionable clinical significance. The reproductive pattern was similar in the two groups and in this study being born VLBW does not seem to affect these measured aspects of reproduction. ABBREVIATIONS: ADHD: attention deficit hyperactive disorder; AGA: average for gestational age; BMI: body mass index; CP: cerebral palsy; DHT: dihydrotestosterone; FSH: follicle stimulating hormone; LBW: low birth weight; LH: luteinizing hormone; SAD: sagittal abdominal diameter; SGA: small for gestational age; SHBG: sex hormone binding globulin; TSH: thyroid stimulating hormone; T3: triiodothyronine; T4: thyroxin; VLBW: very low birth weight.

Most very low birth weight subjects do well as adults.

AIM: To study health, quality of life, educational level and occupation in very low birth weight (VLBW) children in early adulthood and the relationship of the findings to neonatal risk factors and later handicap. METHODS: This is a prospective long-term follow-up study of a regional cohort of 20-year-old VLBW subjects (n = 77) of all surviving VLBW children (n = 86) and 69/86 term controls born in 1987-1988 in the south-east of Sweden. Postal questionnaires were used: 1. A study-specific form, 2. Medical Outcomes Study, Short Form (SF-36), 3. Sense of Coherence. RESULTS: VLBW subjects did not differ significantly from their controls in self-perceived health, use of tobacco, education, occupation and way of living, or scoring on SF-36 and Sense of Coherence. Sixteen had cerebral palsy, attention deficit hyperactivity disorder or isolated mental retardation, and these subjects differed significantly from controls on SF-36 in physical functioning and physical health score, but not on Sense of Coherence. VLBW subjects were significantly lighter and shorter than their controls. Extremely low birth weight (ELBW), bronchopulmonary dysplasia and intraventricular haemorrhage were significantly associated with poorer scores on physical function. CONCLUSION: The 20-year old VLBW subjects reported perceived health and managed transition to adulthood similar to controls. Handicapped subjects had poorer self-perceived physical function. ELBW and severe neonatal complications were associated with poorer self-perceived physical health.

Very-low-birth-weight children at school age: academic achievement, behavior and self-esteem and relation to risk factors.

OBJECTIVE: To investigate school performance, behavior and self-esteem of children with very low birth weight (VLBW). METHODS: All children with birth weight below 1501 g (VLBW) and normal birth weight controls, born in the south-east region of Sweden during a 15-month period in 1987-88, were enrolled in a prospective follow-up study. At the age of 9 years, 81% and 82%, respectively, were re-examined regarding growth, neurofunctional classification, academic achievement tests, need for special education and behavioral problems. At 12 years, 89% and 76%, respectively, were re-examined regarding growth, neurofunctional classification, visual acuity and self-esteem. RESULTS: VLBW children were shorter and lighter, and differed from the controls with regard to neurological functional classification. They produced poorer results in most academic achievement tests. When the comparison was restricted to children with normal intelligence, almost all the differences in other academic achievements disappeared. VLBW children had more reading difficulties but were less often than expected defined as dyslexics compared to control children. We did not find any major disparity in visual acuity and self-esteem between the groups. Low Apgar scores, intracranial hemorrhage and the need for mechanical ventilation neonatally were associated with poorer results in most outcome measures. Neurofunctional assessments in early childhood were associated with most outcome measures. The mother's education was related to delayed reading skills and need for special education. CONCLUSIONS: Although VLBW children performed less well in most academic achievement tests and on some behavioral subscales, those who had a normal intellectual capacity did not differ in any important aspects from the controls.

[School maladjustment common among children with very low birth weight Special attention and support are required during school start]. / Skolsvårigheter vanliga hos barn med mycket låg födelsevikt. Extra uppmärksamhet och stöd behövs vid skolstart.

Children of very low birth weight (VLBW), defined as less than 1500 g, and normal birth weight controls (NBW) were enrolled in a long-term follow-up study. Five of 86 surviving VLBW children had a neurological handicap. Seventy VLBW children and 72 NBW children were re-examined at the age of nine, which entailed a neurological examination, a non-verbal intelligence test and a test for reading ability, mathematical skills and vocabulary. Their behavior was rated regarding hyperactivity, social behavior and fine and motor skills. The two groups differed with regard to the neurological examination and the tests, with poorer results shown for the low birth weight group. The VLBW children were also more hyperactive and scored lower on fine motor skills. Considering only those who scored normally as regards non-verbal intelligence (54% of VLBW children and 88% of controls), practically all differences disappeared.

Morbidity and neurological function of very low birthweight infants from the newborn period to 4 y of age. A prospective study from the south-east region of Sweden.

All 107 infants weighing < or = 1500 g at birth (VLBW) and born alive in the south-east region of Sweden during a 15-month period in 1987-88 were enrolled in a prospective study to determine the prevalence of handicap and to assess neurological function in comparison with controls. Eighty-six (80%) infants survived. Twenty (19%) had intracranial haemorrhages (ICH) assessed by ultrasound examinations in the neonatal period and 2 (2.3%) retinopathy of prematurity stage 3 or more. The VLBW infants who survived had fewer optimal neurological responses than the controls at 40 weeks post-conceptional age. Eighty-two VLBW children were followed to 4 y of age. Three (4%) children had a neurological handicap and 9 (11%) had a moderate neurological deviation. Neither the size of ICH nor neonatal optimality score correlated to neurological outcome at 4 y of age. The VLBW children without neurological handicap or deviation (n = 70) had a delay in psychomotor development in comparison with the controls. Mental development and school performance, in particular language development, will be examined at school age.

[Good prognosis for very low birth weight infants]. / God prognos för barn med mycket låg födelsevikt.

A population-based multicentre study, comprising all very low birthweight (VLBW; < or = 1,500 g) infants born alive in the south-east region of Sweden during a 15-month period, was performed in the late 1980s. Among the VLBW infants there were 107 lifebirths (a rate of 0.72%), 86 (80.4%) neonatal survivors and no late deaths. Twenty (18.4%) had intracranial complications, two (2.3%) retinopathy of prematurity, grade 3, and six (5.6%) bronchopulmonary dysplasia. At follow-up at 18 months of uncorrected age, the VLBW infants were still lighter in weight and of shorter stature than control group infants. Of the five (5.8%) of the surviving VLBW infants who had significant neurological disorder at 18 months of age, all had weighed less than 800 g at birth, and had manifested neurological symptoms at 6 months of age. The hospitalisation rate during the first 18 months of life was greater in the VLBW than the control group.

Brain-orientated intensive care treatment in severe neonatal asphyxia. Effects of phenobarbitone protection.

The effect of applying brain-orientated neonatal intensive care for term infants with severe neonatal asphyxia was studied. Such treatment included protective phenobarbitone administration together with assisted ventilation and other measures to counteract postasphyxial cerebral oedema and any abrupt changes in blood pressure and oxygenation. The mortality rate and incidence of long-term sequelae were reduced appreciably, resulting in a 0-1 year mortality rate of 14% (previously 50%) and an incidence of neurodevelopmental handicap at 18 months of 17% (previously 50%). It is important in the management of infants with severe asphyxia at birth to avoid blood pressure fluctuations and to control neuronal epileptic activity by the use of barbiturates and early ventilator treatment.