Disability rates in preterms

Article Outline

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In this issue of The Journal, Roberts et al report the disability rates for 4 cohorts of infants born between 1979 and 1997 with birth weights of 500-999 grams. The data are valuable because the outcomes of these geographical cohorts were consistently evaluated at 6 years of age. Across the 22 years, survival rate increased greatly, but disability rates were unchanged. Clearly, survivors in this weight range in 1979 were different infants than many of the survivors in 1997. The care strategies for antenatal steroid use, nutrition, ventilation, and most everything else also differed. More smaller and sicker infants survive today, but the disability rate remains unchanged and very high relative to term infants. The causes of the disabilities also may differ, but we have little insight into mechanisms of injury and how to decrease disability rates. The societal problem is that we are generating more disabled children as a result of the successes of neonatology.