Outcome of Very Low Birth Weight Infants
at 12 to 18 Months of Age in Soweto, South Africa

Pediatrics v.99, n.4, Apr97

Received Dec 6, 1995; accepted Apr 22, 1996.

Peter A. Cooper and Daniel L. Sandler

From the Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.

Objective.
To describe the long-term outcome of very low birth weight infants growing up in poor socioeconomic conditions in Soweto, South Africa.

Methods.
A stratified sample of infants weighing <1500 g surviving to hospital discharge was enrolled. Group 1 consisted of 49 infants 1000 to 1499 g who required mechanical ventilation; group 2 consisted of 39 infants 1000 to 1499 g who did not require mechanical ventilation; and group 3 consisted of 25 infants <1000 g (such infants are not routinely ventilated). Growth and neurological status were recorded at follow-up visits at 3, 6, and 12 months' corrected age and the infants were evaluated further using the Bayley scales of infant development between 12 and 18 months.

Results.
Fifteen infants died during the period between hospital discharge and 1 year corrected age, and 12 others were lost to follow-up. Although some catch-up growth was noted in the early months, all group means for weight and length were below the 25th percentile at 1 year. Cerebral palsy was diagnosed in nine infants (8 from group 1). Periventricular leukomalacia and/or porencephaly was diagnosed in eight of the nine infants during their initial hospital stay and was also the strongest negative predictor of the Bayley scores. Higher maternal education and better intrauterine growth were associated with higher Bayley scores.

Conclusions.
Mortality after hospital discharge in this study cohort was extremely high. However, despite marked differences in socioeconomic conditions and tertiary care facilities, the handicap rates were comparable with recent studies from developed countries, and some of the predictors of handicap, eg, periventricular leukomalacia and porencephaly, were also similar.

Key words: very low birth weight, follow-up, growth, developmental outcome, handicap, developing country.