144 Journal of Intellectual Disability - Diagnosis and Treatment, 2014, 2, 144-154 E-ISSN: 2292-2598/14 © 2014 Lifescience Global Preterm Infants’ Follow-Up Program at a Public Hospital in Buenos Aires: Two-Decade Study N. Aspres * , I. Schapira, A. Benitez, A. Galindo, M. Brundi, L. Kasten, V. Feld, G. Granovsky, G. Allignani, A. Fiorentino, M. Cuneo-Libarona, S. Vivas, G. Gerometta, M.A. Gonzalez and A.B. Álvarez Gardiol Pediatrics Outpatient Department, Hospital Materno Infantil Ramón Sardá, Buenos Aires, Argentina Abstract: Objectives: To analyze temporal trends of mortality, morbidity, growth and neurodevelopment until 2 years of corrected age (CA) of very low birth weight infants (VLBWI) born between 1986- 2005 in Ramon Sardá Maternal Infant Hospital (RSMIH). Methods: Descriptive temporal trend study divided in 5 quinquenniums. 1255 VLBWI were born at RSMIH between 1986-2005; 46 were excluded (genetic syndromes, major congenital malformations, confirmed intrauterine infections), 84 were referred out and 1125 were studied. Birth weight (BW), gestational age (GA); morbidity; growth; neurodevelopment at 1 and 2 years of CA; neurological and sensorial disorders, antenatal steroids use, breastfeeding; rehospitalizations; mothers´ age and years of schooling and Unsatisfied Basic Needs Index (UBNI) were recorded. Results: Survival rates increased during the last two periods, especially in <1000g BW infants despite the decrease in GA and BW. Children receiving surfactant (Sf), parenteral nutrition (PN) and antenatal steroids (AS) in the last quinquennium obtained better results in growth (40 weeks GA and 1 CA). The use of these therapies increased greatly in the last decade. Also breastfeeding at 40 weeks GA and 4 months tended to be better. Bronchopulmonary dysplasia (BPD) increased. Rehospitalizations (majorly attributable to lower tract infections) and UBNI stayed equal all along. Mothers’ years of schooling increased a little in the last two quinquenniums. Conclusion: In the last quinquennium children tended to be smaller in GA and BW due to an increase in the survival rate as a result of higher technology and appropriate interventions such as AS, PN, Sf, etc. Keywords: Preterm, growth, morbidity, mortality, neurodevelopment. INTRODUCTION Preterm birth (PB) is a major burden and there are approximately 15 million of them worldwide. Very low weight infants (VLWI <1500g) represent approximately 1% of still births, and extremely low birth weight infants (ELBWI<1,000g) between 0.3% and 0.5% [1-3]. PB is associated with many specific acute complications of immaturity including bronchopul- monary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), periventricular leukomalacia (PVL) and retinopathy of prematurity (ROP) [1, 2]. There is good evidence that advances in perinatal care including sophisticated ventilator techniques, antenatal steroids (AS). pulmonary surfactant (Sf), parenteral nutrition (PN), skin-to-skin mother-infant contact (kangaroo mother care), early breastfeeding, mothers’ residency, and professional development, have resulted in improved survival rates of VLBWI and ELBWI over the last three decades [2, 4-11]. *Address correspondence to this author at the Department of Pediatrics Outpatient, Hospital Materno- Infantil “Ramón Sardá”, Esteban de Luca 2151, (1246) Ciudad Autónoma de Buenos Aires, Argentina; Tel: (54 11) 49.43.35.67; Fax: (54 11) 49.43.77.79; E-mail: naspres@fibertel.com.ar Although improvements in the care of newborn babies (neonatal care) mean that preterm babies are more likely to survive than in the past with smaller gestational age (GA), PB remains the single biggest cause of infant death and the second most common cause of death in children under-five after pneumonia [1, 12]. PB also increases the risk of death due to neonatal infections. Moreover, hypothermia and malnutrition increase vulnerability. PB is a direct cause of 36% of all infant deaths, but two-thirds of all infant deaths are among babies who were born preterm [1, 2, 12]. In Argentina 65% of neonatal and 34% of under- one infants’ deaths are associated to VLBW, determined by the type and quality of the institution [6, 13]. As regards of rehospitalizations in VLBWI, the percentage reaches around 20-40% and doubles that of term infants under 1 year old [14]. In addition to its contribution to mortality, PB may lead to long-term health problems and disabilities by reason of a higher vulnerability in a wide spectrum of developmental domains. There are lifelong effects on neurodevelopment, increased risks of cerebral palsy (CP), impaired learning, mental /behavioral and sensorial disorders, and cognitive and language delays, hyperkinetic disorders, emotional problems, and learning disabilities, which contribute to the For Author's Personal Use