Since 1980, the preterm (<37 weeks gestational age) birth rate, as well as the LBW (<2500gm at birth) rate, have been generally increasing in the U.S. In 2008, the last year for which data is available, the preterm birth rate was 12.3% and the LBW rate was 8.2%. In real numbers, this means about 14,000 preterms and 10,000 LBWs born per year in Michigan alone. Coupled with this has been a trend toward increased survival of prematures. A baby born at 26 weeks, weighing 800gm, has an 80% survival rate, while more than 90% of extremely low birth weight (ELBW) babies (<1000gm birthweight) survive. In fact, even babies born at 24-25 weeks have a 40-50% chance of surviving.

Also well documented is the significant handicap rate of 25-35% for ELBWs. Of course this reported rate only includes major CNS handicaps (discussed later). It does not take into account minor handicaps or other medical problems. There are also a wide variety of functional limitations that may occur in preterms without regard to specific diagnoses. These include:

Studies that have looked at NICU survivors without disabilities report a disappointingly low number - e.g. in one study only 18% of those <1000gm at birth both survived and were normal.

This all translates into a potentially significant ongoing burden after NI discharge for both parents and pediatricians. Some of the outpatient needs of NI babies are basically the same as for fullterms but with some modification due to prematurity - newborn screening, monitoring of growth parameters, hearing screening. Others are fairly standard applying to broad ranges of birthweight and gestational age categories - developmental assessment, immunizations, car seat testing, ophthalmology followup. Still others are unique, related to specific diseases encountered during the NI stay. The second half of this lecture is devoted to these specific NI problems and their particular outpatient needs.