A longitudinal study of very low-birthweight infants. IV: An overview of performance at eight years of age.

A cohort of 169 very low-birthweight infants (800 to 1500g) was followed prospectively to the age of eight years. Information on 159 of the children was available at that age, and for a further five to the age of six years. A comparison group of 67 normal-birthweight children was also followed, but only 43 of these children were seen at the age of eight years. Eight of the very low-birthweight (VLBW) children were attending special schools and 156 attended normal schools: placement of the remaining five was unknown. Of the VLBW children who were adequately assessed, 15.9 per cent were either not reading or were retarded by more than 18 months. Mean VLBW full-scale IQ was 88.8, compared with 98.8 for the normal-birthweight group. A subgroup of 10 VLBW children with birthweights under 1000g had lower mean scores on all three WISC-R scales compared with those with birthweights between 1000 and 1500g. Of the adequately assessed VLBW children, 3.7 per cent had epilepsy, 3.7 per cent had significant sensorineural deafness and 2.4 per cent suffered from cerebral palsy. One or more visual defects were detected in 31.4 per cent of the children, though in only 3.8 per cent was the defect serious. At eight years, growth dimensions for the VLBW children were below the 10th percentile for 11.0 per cent in weight, 16.1 per cent in height and 15.0 per cent in head circumference. Degrees of handicap in the VLBW children were profound in 5.1 per cent, severe in 10.8 per cent and significant in 40.5 per cent: handicap was minimal or absent in the remaining 43.6 per cent. For the normal-birthweight group the percentages were 2.3, 0, 25.6 and 72.1 respectively. The VLBW children with minimal or no handicap were considered to have a satisfactory outcome. This was significantly correlated with the following: gestation over 30 weeks; birthweight over 1199g; no major apnoeic attacks; lowest postnatal weight before six days; return to birth weight before 21 days; peak serum bilirubin not exceeding 255 mumol/litre; and parental social-class between 2 and 5 on the seven-point Congalton Scale.