A Girl with a Birth Weight of 280 g, Now 14 Years Old
http://www.100md.com
《新英格兰医药杂志》
To the Editor: One of us and several colleagues previously reported in the Journal the survival, at 18 months of age, of a girl with extreme symmetrical intrauterine growth restriction; she had a birth weight of 280 g and a length of 25 cm at a gestational age of 26 weeks and 6 days.1 To our knowledge, her birth weight remains the lowest in the world literature. We now report her growth and development at 14 years of age, as she enters high school (Figure 1).
Figure 1. The Patient at 14 Years of Age.
At two years of age, our patient had a Mental Development Index score of 86 (normal range, 84 to 116) on the Bayley Scales of Infant Development and was walking independently. Toilet training took place at three years of age. At five years of age, her visual acuity was 20/200 (in the right eye) and 20/100 (in the left) and was corrected with eyeglasses. Her only hospitalization was at four years of age, for pneumonia. She continues to have reactive airway disease. She started kindergarten at six years of age. A workup for failure to thrive and short stature at three and nine years of age, respectively, revealed no abnormalities. Menarche occurred at 13 years of age. She attends a regular school and has a cumulative grade-point average of 3.70 (of a possible 4.00) for the previous eight years. Since her birth, she has gained an average of 1.8 kg in weight and 9.7 cm in height annually. The 50th percentile for weight and height for girls at the age of 14 years are 50 kg and 163 cm, respectively. Despite her present weight of 25.4 kg and height of 136.5 cm, no psychosocial maladaptations have been reported. The results of her high-school entrance examinations were in the 83rd percentile nationally.
Neonatal survival improves dramatically from 5 percent at a gestational age of 23 weeks to 90 percent at a gestational age of 27 weeks. Despite the routine use of antenatal and postnatal corticosteroids, surfactants, and aggressive ventilation, prospective studies have demonstrated that newborns delivered before 24 weeks of gestation have been completed are less likely to survive and to survive without deficits than are those delivered after a longer gestation. Girls generally have a better prognosis than boys.2 The normal cognitive development of our patient is more remarkable than her survival. A significant number of newborns with an extremely low birth weight (<1000 g) and intrauterine growth restriction who have been followed to school age have suboptimal neurodevelopmental outcomes and cognitive function.3,4 Fifty-two newborns with a birth weight of less than 400 g have been described in the literature. Their average gestational age was 25 weeks and 6 days, and 83 percent were girls. All had symmetrical intrauterine growth restriction.5 These extremely low-birth-weight, "miracle" newborns can propagate false expectations for families, caregivers, and the medicolegal community alike. Gestational age and female sex are critical characteristics in newborns at the threshold of viability.
Jonathan Muraskas, M.D.
Loyola University Medical Center
Maywood, IL 60153
jmurask@lumc.edu
Albert Hasson, M.D.
Northwest Pediatrics
Schaumberg, IL 60194
Richard E. Besinger, M.D.
Loyola University Medical Center
Maywood, IL 60153
References
Muraskas JK, Carlson NJ, Halsey C, Frederiksen MC, Sabbagha RE. Survival of a 280-g infant. N Engl J Med 1991;324:1598-1599.
American College of Obstetrics and Gynecology. ACOG practice bulletin. Perinatal care at the threshold of viability. No. 38, September 2002. Int J Gynaecol Obstet 2002;79:181-188.
Anderson P, Doyle LW. Neurobehavioral outcomes of school-age children born extremely low birth weight or very preterm in the 1990s. JAMA 2003;289:3264-3272.
Regev RH, Lusky A, Dolfin T, Litmanovitz I, Arnon S, Reichman B. Excess mortality and morbidity among small-for-gestational-age premature infants: a population-based study. J Pediatr 2003;143:186-191.
University of Iowa Registry. The Tiniest Babies. (Accessed July 30, 2004, at http://www.medicine.uiowa.edu/tiniestbabies/index.htm.)
Figure 1. The Patient at 14 Years of Age.
At two years of age, our patient had a Mental Development Index score of 86 (normal range, 84 to 116) on the Bayley Scales of Infant Development and was walking independently. Toilet training took place at three years of age. At five years of age, her visual acuity was 20/200 (in the right eye) and 20/100 (in the left) and was corrected with eyeglasses. Her only hospitalization was at four years of age, for pneumonia. She continues to have reactive airway disease. She started kindergarten at six years of age. A workup for failure to thrive and short stature at three and nine years of age, respectively, revealed no abnormalities. Menarche occurred at 13 years of age. She attends a regular school and has a cumulative grade-point average of 3.70 (of a possible 4.00) for the previous eight years. Since her birth, she has gained an average of 1.8 kg in weight and 9.7 cm in height annually. The 50th percentile for weight and height for girls at the age of 14 years are 50 kg and 163 cm, respectively. Despite her present weight of 25.4 kg and height of 136.5 cm, no psychosocial maladaptations have been reported. The results of her high-school entrance examinations were in the 83rd percentile nationally.
Neonatal survival improves dramatically from 5 percent at a gestational age of 23 weeks to 90 percent at a gestational age of 27 weeks. Despite the routine use of antenatal and postnatal corticosteroids, surfactants, and aggressive ventilation, prospective studies have demonstrated that newborns delivered before 24 weeks of gestation have been completed are less likely to survive and to survive without deficits than are those delivered after a longer gestation. Girls generally have a better prognosis than boys.2 The normal cognitive development of our patient is more remarkable than her survival. A significant number of newborns with an extremely low birth weight (<1000 g) and intrauterine growth restriction who have been followed to school age have suboptimal neurodevelopmental outcomes and cognitive function.3,4 Fifty-two newborns with a birth weight of less than 400 g have been described in the literature. Their average gestational age was 25 weeks and 6 days, and 83 percent were girls. All had symmetrical intrauterine growth restriction.5 These extremely low-birth-weight, "miracle" newborns can propagate false expectations for families, caregivers, and the medicolegal community alike. Gestational age and female sex are critical characteristics in newborns at the threshold of viability.
Jonathan Muraskas, M.D.
Loyola University Medical Center
Maywood, IL 60153
jmurask@lumc.edu
Albert Hasson, M.D.
Northwest Pediatrics
Schaumberg, IL 60194
Richard E. Besinger, M.D.
Loyola University Medical Center
Maywood, IL 60153
References
Muraskas JK, Carlson NJ, Halsey C, Frederiksen MC, Sabbagha RE. Survival of a 280-g infant. N Engl J Med 1991;324:1598-1599.
American College of Obstetrics and Gynecology. ACOG practice bulletin. Perinatal care at the threshold of viability. No. 38, September 2002. Int J Gynaecol Obstet 2002;79:181-188.
Anderson P, Doyle LW. Neurobehavioral outcomes of school-age children born extremely low birth weight or very preterm in the 1990s. JAMA 2003;289:3264-3272.
Regev RH, Lusky A, Dolfin T, Litmanovitz I, Arnon S, Reichman B. Excess mortality and morbidity among small-for-gestational-age premature infants: a population-based study. J Pediatr 2003;143:186-191.
University of Iowa Registry. The Tiniest Babies. (Accessed July 30, 2004, at http://www.medicine.uiowa.edu/tiniestbabies/index.htm.)