In our country, survival of infants born with birth weight <1500 grams continues to improve. At the same time that neonatal intensive care started to become generalized over a decade ago, we developed a center to perform specialized longitudinal assessment of the progress of infants discharged from neonatal units. Follow up visits occur at regularly scheduled intervals and is provided to all survivors <1500 gm. Detailed clinical neurological and growth and developmental evaluations are performed in each visit. Furthermore, electrophysiological studies including electroencephalograms (EEG), brain stem and visual evoked potentials are performed at regular, well defined, intervals. Ophthalmologic, nutritional, respiratory and metabolic evaluations are also performed in this interdisciplinary clinic. For this prospective longitudinal study we report detailed follow-up, until 3 years of“corrected” age, for 86 consecutive survivors born during the previous three years at Gonzalez Coro Hospital in Habana city, Cuba. The infants were treated in the Level III neonatal unit at the same hospital of birth. The babies were included in the study soon after birth in order to analyze factors for early prediction of serious neurodevelopmental abnormalities. Infants were evaluated by professionals unaware of results of predictive data collected. There were 26 infants who were intubated and treated with intermittent mandatory mechanical ventilation (IMMV) and other infants who did not receive IMMV (n=60). The groups were similar in relation to birth weight, sex, gestational age and route of delivery. Among the infants treated with IMMV, 19.2% were severely abnormal at 3 years, compared to only 1.7% in the group with CPAP, oxygen or no respiratory support at all. Other than IMMV, independent variables for severe disabilities were weight <1250 gm, hyaline membrane disease and patent ductus arteriosus. By multiple logistic regression analysis we found that a detailed neurological exam performed at “term” post conceptional age, an EEG at the same age and positive ultrasound findings at <96 Hs were excellent predictors for severe long term neurodevelopmental abnormalities in infants < 1500 grams, independently of IMMV treatment. For cost efectiveness we now select which infants enter the specialized follow up and intervention program based on scores predictive of real high risk for long term abnormalities and not solely based on certain cut-off birth weight, gestational age or the use of IMMV.
