Outcome of the extremely low birth weight infants (less than 999 grams): what messages are we getting?

The outcome of the extremely low birth weight (less than 1,000g or ELBW) babies continues to improve. More ELBW babies are surviving, though some of them may have various degrees of impairment or disability. The chance of dying or surviving with a major disability or cerebral palsy declines significantly in recent years in the developed countries. The implication of these findings is that application of neonatal care does not increase the risk of disabled survival as has been often feared but promoted normal survival. Great effort has been put in to achieve good results and better outcome. Developing countries however, will face a problem of achieving similar results because of limited resources or priority of allocation of limited resources, inadequate facilities, lower socio-economic status, poor home environment and lack of follow-up services, training and rehabilitation set-ups or intervention programme. What is the relevance of these good results in relation to the developing or third world countries? The limit of viability may have to be redefined. Nevertheless, it should be the aim to lower the mortality of these high risk babies and to reduce complications and morbidity of the survivors. Maintenance and control of body temperature, control of infections, blood sugar monitoring, antenatal steroids for the mother in premature labour, resuscitation at birth or even simple nasal continuous positive airway pressure (CPAP) should come a long way in fulfilling these goals. Those ELBW children who survive without neurological damage may have learning difficulties. It is necessary to find out the reasons for that such as the impact of the home environment on mental development. Do the children have a good background conducive for learning? Are there establishments for intervention programme in the community for these high risk children? The ratio of neonatal beds per 1,000 deliveries may have to be reviewed now that more ELBW infants are staying in the hospital for a longer period, and surviving.