PubMed · 14558421
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Janice Fisher. 2003. Speeding ahead.. https://pubmed.ncbi.nlm.nih.gov/14558421/
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Developmental disabilities (DDs) are chronic conditions that initially manifest in persons aged < or =18 years and result in impairment of physical health, mental health, cognition, speech, language, or self-care. The majority of persons with DDs require long-term supportive care or services. In 2003, RTI International (Research Triangle Park, North Carolina) and CDC analyzed data from multiple surveys and reports to estimate the direct and indirect economic costs associated with four DDs in the United States. On the basis of that analysis, estimated lifetime costs in 2003 dollars are expected to total 51.2 billion dollars for persons born in 2000 with mental retardation, 11.5 billion dollars for persons with cerebral palsy, 2.1 billion dollars for persons with hearing loss, and 2.5 billion dollars for persons with vision impairment. These estimates underscore the need for effective primary and secondary prevention measures (e.g., newborn screening for hearing and metabolic disorders and smoking-cessation counseling for pregnant women) to reduce the costs associated with DDs.
The study of the long-term outcome of extremely premature babies is specially difficult because data in the literature is very heterogeneous. Recruitment (inborn, outborn), type of obstetrical management, and criteria and means used for interrupting curative treatment have varied greatly. We present the outcome of 204 infants born before 28 weeks of gestation between 1992 and 1997. The minimal follow up is 6 years. 82 infants (40.2%) died during the neonatal period. Significantly associated with neonatal death were absence of prenatal steroid course, male gender, elevated lactic acid at birth, and occurrence of pulmonary complications. When major neurological lesions (ventricular hemorrage stage III or IV and kryptic leucomalacia) developed, most infants died following a decision to stop active treatment. Out of the 114 survivors, 17 (14.9%) developed cerebral palsy (CP) or a low IQ. 31 (27.2%) had minor disorders, 66 (57.9%) were completely normal. The predictive factors of CP were major brain lesions, elevated lactic acid at the time of birth and multiple pregnancy. We also detail the minor neurological sequelae, cognitive behavioral, and psychological disorders observed in this population of extremely premature children and discuss the need for early and continuous care for these high risk babies.