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41 EXTREMELY LOW BIRTHWEIGHT INFANTS: LIVE OR LET DIE?

As part of the national collaborative study in The Netherlands on very preterm and very low birthweight infant liveborn in 1983, we studied mortality and disabilities at 5 years of age in 292 infants with birthweight below 1000 grams. Mortality was 55.5%; in more than half of these cases, treatment was withheld or withdrawn. In 128 of 130 surviving children a detailed neurodevelopmental assessment was done during a home visit by 1 of 3 specially trained paediatricians. According to the WHO definitions1 38 children (29.7%) had a disability of which 16 (12.5%) had a minor handicap and 6 (4.7%) a major handicap.Although birthweight was clearly related to mortality, withdrawal of treatment was evenly distributed over all birthweight categories, and disabilities or handicaps showed no association with birthweight within this studygroup. We conclude that, given the permissive attitude on withholding or withdrawal of treatment in The Netherlands, tiny babies have a higher mortality risk, but in surviving children the disability and handicap percentages are similar to that in survivors of 1000-1500 g (disabilities 28.22, handicaps 14.3%).