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The level of neonatal and perinatal care that is provided has been improving over the past few decades. This improved care has resulted in better outcomes of extreme premature babies. To examine the effect of the improved quality of care we performed a study on infants that were admitted to our NICU. Seventy-one infants born at a gestational age of 28 weeks or less were admitted to the St. Vincent's Medical Center Level III NICU. Twenty-four of these infants (33.8%) died and forty-seven (66.2%) survived. The mean gestational age of all the admissions was 25.7 weeks. Of the infants who died the mean age was 24.9 weeks, while those survived had an average gestational age of 26.5 weeks. Thirty-four of the infants who survived (72.3%)were followed to assess their neuro-developmental outcome. Most of these infants required ventilatory support for RDS/BPD. The ventilatory days ranged from 2 to 74 days and the length of stay ranged from 53 to 128 days. The incidence of IVH in the infants who were followed was 14.8%. Of the 34 infants, three had a grade II bleed and two had a grade III bleed; two of these required a VP shunt for hydrocephalous. The incidence of ROP in the 34 infants followed was 70%; 12 of them had stage II and 12 had stage III. Of the 12 babies who had stage III ROP, 5 of them required cryotherapy. For developmental assessment the Bayley Test and the neurological examination was performed at 18 months corrective age. This revealed that 7 infants (20%) had a significant delayed performance, 5 infants (14.7%) had mildly delayed performance, and another 5 infants (14.7%) had minimum motor function impairment. The development of the remaining infants has been as expected given their age. As a whole, the incidence of the problems mentioned above has decreased over the years to the levels stated. As the rapid progress in medical care is resulting in increased survival of very low birth weight infants, long term follow-up of these babies is warranted to assess their developmental outcome.

The objective of our study is to reassess the need of routine cranial ultrasound to rule out intraventricular bleed in all neonates with birthweights less than 1500 grams and gestational age less than 32 weeks. For this, we studied 134 babies with birthweights of 500-1500 grams, born between January, 1993 and December, 1994, at St. Vincent Medical Center Level III NICU. Of these, 105 (78.4%) babies survived. Subsequently, we studied 99(94.3%) of the babies who survived using cranial ultrasounds to rule out intraventricular bleed. Of the babies studied, only 12 (12.12%) developed intraventricular bleeding - 6 of them were Grade I and 6 were Grade III. The gestational age of these 12 babies varied from 24 weeks to 30 weeks with a mean gestational age of 26.6 weeks. The birth weight ranged from 605 to 1415 grams with a mean of 961 grams. All babies with bleeding had a significant Respiratory Distress Syndrome, required ventilatory support (required CPAP, IMV or HFV) and developed Broncho-Pulmonary Dysplasia. Three of these babies developed Patent Ductus Arteriosis and required treatment with indomethasin. One infant also had Group-B Streptococcus sepsis. The rest of the infants who had no significant illnesses (transient tachypnea or mild RDS and required oxyhood, etc.) did not develop any bleeding. Therefore, we feel that very low birth weight infants with mild or no illness do not need to be routinely screened for intracranial bleeding. However, further studies need to be done to support these results.