64 Targeting Follow-Up Needs of Premature Survivors

The objective was to analyze the neonatal morbidities and functional outcomes (using the preschool version of the Health Status Classification System (HSCS)) at 42 months age by 3 different neonatal follow-up recruitment criteria used in Canada (birth weight <801 grams, <1251 grams, <1501 grams) and control patients born in a 22 month period in 1996–97 in a population based sample in British Columbia. The HSCS captures domains typically addressed in neonatal follow-up programs. Results of a cross sectional survey were linked to Canadian Neonatal Network (CNN) data. Incidence of neonatal major morbidities (chronic lung disease, severe intraventricular hemorrhage, necrotising enterocolitis or retinopathy of prematurity) and functional outcomes measured by the HSCS were calculated for survivors in the 3 recruitment criteria above. The Cochran-Armitage Trend Test was used to assess linear trends for incremental groups (<801 g, 801–1250 g, 1250–1500 g and controls) and the effect of morbidities on the HSCS. All 329 subjects <1500 grams birth weight born were cared for in a NICU. The survey was completed by caregivers for 161 subjects. Nonrespondents did not differ significantly in neonatal morbidities or risk factors. 393 of 718 control subjects' caregivers completed the survey. The incidence of major morbidity was 75% <801 g, 40% <1251 g and 28.8% of <1501 g. One or more health problems on the HSCS (HSCS sum) was identified by 78.3% <801 g, 70.2% <1251 g, 68.3% <1501 g and 45% of controls. The greatest differences between groups (p<.001) were seen for vision, gross motor, fine motor, self care, learning, thinking and pain. Small differences were seen in speaking and general health and no differences in hearing, feelings and behaviour. There were statistically significant differences between incremental groups for major morbidities (p<0.0001) but not against HSCS sum (p=.16). Morbidity and HSCS were not significantly correlated for 2 of 3 recruitment groups. The incidence of major neonatal morbidities and most health issues as measured by the components of the HSCS decrease significantly with higher birth weight recruitment criteria but overall having at least one health issues was very common (68%) in <1501 g survivors. Together with evidence from the literature, these results can be used to design follow-up strategies to better target the needs of premature survivors.