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OBJECTIVE. Our goal was to investigate whether outcome in extremely low birth weight infants changes over time in Finland. PATIENTS AND METHODS. All infants with a birth weight < 1000 g born in Finland in 1996-1997 and 1999-2000 were included in the study. Perinatal and follow-up data were collected in a national extremely low birth weight infant research register. Data concerning cerebral palsy and visual impairment were obtained from hospitals, the national discharge, and visual impairment registers. RESULTS. A total of 529 and 511 extremely low birth weight infants were born during 1996-1997 and 1999-2000. No changes were detected in prenatal, perinatal, neonatal, and postneonatal mortality rates between the periods. The survival rates including stillborn infants were 40% and 44%. The incidence of respiratory distress syndrome and septicemia increased from 1996-1997 to 1999-2000 (75% vs 83% and 23% vs 31%). The overall incidence of intraventricular hemorrhage increased (29% vs 37%), but the incidence of intraventricular hemorrhage grades 3 through 4 did not (16% vs 17%). The rates of oxygen dependency at the age corresponding with 36 gestational weeks, retinopathy of prematurity stages 3 to 5, cerebral palsy, and severe visual impairment did not change. Mortality remained higher in 1 university hospital area during both periods compared with the other 4 areas, but no regional differences in morbidity were detected during the later period. CONCLUSIONS. No significant changes were detected in birth or mortality rate in extremely low birth weight infants born in Finland during the late 1990s, but some neonatal morbidities seemed to increase. Regional differences in mortality were detected in both cohorts. Repeated long-term follow-up studies on geographically defined very preterm infant cohorts are needed for establishing reliable outcome data of current perinatal care. Regional differences warrant thorough audits to assess causalities. Key Words low gestational age, mortality, neonatal morbidity, cerebral palsy, visual impairment, THE MORE ACTIVE approach to antenatal and perinatal treatment of most immature infants has recently been shown to decrease stillbirth rates and increase the survival at gestational weeks (GWs) from [...]

Objective. Increasing survival of extremely low birth weight (ELBW; birth weight Methods. Of all live-born ELBW infants (n = 351) who were delivered in the 2-year period 1996-1997 in Finland, 206 (59%) survived until the age of 5 years. Of these, 103 were born at Results. The rate of cognitive impairment in the ELBW survivors was 9%. The rate of cerebral palsy was 14% (19% of ELBW infants who were born at Being small for gestational age at birth was associated with suboptimal growth at least until age 5. Conclusions. Only one fourth of the ELBW infants were classified as normally developed at age 5. The high rate of cognitive dysfunction suggests an increased risk for learning difficulties that needs to be evaluated at a later age. Extended follow-up should be the rule in outcome studies of ELBW infant cohorts to elucidate the impact of immaturity on school achievement and social behavior later in life. extremely preterm infants, neurocognitive function, developmental follow-up, neurologic outcome, long-term outcome. ABBREVIATIONS. ELBW, extremely low birth weight; CP, cerebral palsy; GW, gestational weeks; SGA, small for gestational age; AGA, appropriate for gestational age; MND, minor neurological dysfunction; WPPSI-R, the Wechsler Preschool and Primary Scale of Intelligence-Revised; ROP, retinopathy of prematurity; NEPSY, Developmental Neuropsychological Assessment; CI, confidence interval; OR, odds ratio., The increasing survival of extremely low birth weight (ELBW; birth weight The aim of this prospective study was to assess the long-term outcome of a national population-based birth cohort of [...]

Our aim was to study the impact of preterm birth and neonatal therapies on the risk of childhood cancer using a nationwide, registry‐based, case‐control design. Combining population‐based data from Finnish Medical Birth Registry (MBR) and Finnish Cancer Registry, we identified a total of 2029 patients diagnosed with cancer under the age of 20 years and 10 103 age‐ and sex‐matched controls over the years 1996 to 2014. Information on the prenatal and perinatal conditions was obtained from the MBR. Gestational age was categorized into early (<32) and late preterm (32‐36) and term (≥37 weeks). Cancer risk among the preterm compared to term neonates was evaluated using conditional logistic regression. We identified 141 cancers among the preterm (20.8% of 678) vs 1888 cancers in the term children (16.5% of 11 454). The risk of any cancer was increased for the preterm (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.06‐1.57), especially for the early preterm (OR 1.84, 95% CI 1.16‐2.92). The risk of acute myeloid leukemia (AML; OR 2.33, 95% CI 1.25‐4.37), retinoblastoma (OR 3.21, 95% CI 1.22‐8.41) and germ cell tumors (OR 5.89, 95% CI 2.29‐15.18) was increased among the preterm compared to term. Germ cell tumors were diagnosed at a significantly younger age among the preterm. Neonatal therapies, for example, mechanical ventilation, were associated with an increased risk of childhood cancer independent of gestational age. Preterm, especially early preterm birth, is associated with an increased risk of childhood cancer, especially germ cell tumors and AML. Respiratory distress requiring neonatal intervention also appears to be associated with an increased risk. What's new? Although many of the long‐term effects of preterm birth and related treatments have been explored, their association with the risk of malignancy largely remains to be delineated. This nationwide, registry‐based, case‐control design study suggests an association between preterm birth, especially early‐preterm birth, and childhood cancer. The risk of acute myeloid leukemia and solid tumors, especially germ cell tumors and retinoblastoma, was found to be increased. Neonatal therapies and/or perinatal hypoxia also appear to be associated with an increased risk of childhood cancer. Altogether, the findings suggest that the apparent cancer risk should be included in the follow‐up of these children. [ABSTRACT FROM AUTHOR]

Background and aims: Children with extremely low‐birth weight (ELBW) have a high risk for cognitive, motor, and attention impairments and learning disabilities. Longitudinal follow‐up studies to a later age are needed in order to increase understanding of the changes in neurodevelopmental trajectories in targeting timely intervention. The aims of this study were to investigate cognitive and motor outcomes, attention‐deficit hyperactivity (ADHD) behaviour, school performance, and overall outcomes in a national cohort of ELBW children at preadolescence, and minor neuromotor impairments in a subpopulation of these children and to compare the results with those of full‐term controls. The additional aim was to report the overall outcome in all ELBW infants born at 22 to 26 gestational weeks. Methods: This longitudinal prospective national cohort study included all surviving ELBW (birth weight <1000 g) children born in Finland in 1996 to 1997. No children were excluded from the study. Perinatal, neonatal, and follow‐up data up to the age of 5 years of these children were registered in the national birth register. According to birth register, the study population included all infants born at the age under 27 gestational weeks. At 11 years of age general cognitive ability was tested with the Wechsler Intelligence Scale for Children, ADHD behavior evaluated with a report from each child's own teacher (ADHD Rating Scale IV), and school performance with a parental questionnaire. An ELBW subpopulation consisting of a cohort representative children from the two university hospitals from two regions (n = 63) and the age‐matched full‐term born controls born in Helsinki university hospital (n = 30) underwent Movement Assessment Battery for Children and Touwen neurological examination comprising developmental coordination disorder (DCD) and minor neurological dysfunction (MND), respectively. Results: Of 206 ELBW survivors 122 (73% of eligible) children and 30 (100%) full‐term control children participated in assessments. ELBW children had lower full‐scale intellectual quotient than controls (t‐test, 90 vs 112, P < .001), elevated teacher‐ reported inattention scores (median = 4.0 vs 1.0, P = .021, r = .20) and needed more educational support (47% vs 17%, OR 4.5, 95% CI 1.6‐12.4, P = .02). In the subpopulation, the incidences of DCD were 30% in ELBW and 7% in control children (P = .012, OR 6.0 CI 1.3‐27.9), and complex MND 12.5% and 0%, (P = .052; RR 1.1 95% CI 1.04‐1.25), respectively. Of survivors born in 24 to 26 gestational weeks, 29% had normal outcome. Conclusion: As the majority of the extremely preterm born children had some problems, long‐term follow‐up is warranted to identify those with special needs and to design individual multidisciplinary support programs. [ABSTRACT FROM AUTHOR]

Perinatal asphyxia may lead to neurologic injury and death of the newborn infant. Hypothermia therapy seems to lower this risk. For the present retrospective study, the patient record data of both the mother and the child were collected for the newborn infants treated with hypothermia therapy in 2007-2010 in Helsinki University Central Hospital. Of the 61 children treated with hypothermia therapy, 12 died. Resuscitation response, severity of hypoxic-ischemic encephalopathy, EEG and MRI findings may provide more information than the baseline condition about the prognosis of infants treated with hypothermia therapy.

Mortality among low birthweight infants has decreased and their neurological prognosis has improved over the recent decades. A major neurological impairment is, however, still found at preschool age in almost one fifth of those born with a birthweight of less than 1000 g. They often have difficulties in scholastic skills and become independent more slowly than their age-mates, but most of them will lead a normal adult life. They do, however, possess more risk factors of cardiovascular disease as compared with those born after a full-term pregnancy. In adult life these premature infants instead exhibit less high-risk behavior.