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Are we improving long-term outcomes for extremely preterm babies?
Survival rates for extremely preterm or tiny babies have increased dramatically with advances in perinatal and neonatal intensive care. However, the rates of neurological impairments and disabilities are too high in survivors relative to term controls; major neurological disability rates in those < 1000 g or < 28 weeks are four to five times higher than in term controls. There are some recent advances, however, that improve the outcome, both short and long term, for extremely preterm or tiny babies. Magnesium sulphate given to the mother just prior to very preterm birth reduces the rate of cerebral palsy in survivors. Caffeine given to very tiny babies not only reduces several short-term morbidities, such as patent ductus arteriosus and bronchopulmonary dysplasia, but also reduces the rates of death or disability, cerebral palsy and cognitive delay. Docosahexanoic acid, an omega-3 fatty acid important in brain function, given as a supplement to feeds in very preterm babies, improves cognitive function, but mostly in females and in those < 1250 g birthweight. Developmental interventions after discharge home designed to improve baby cognitive and motor development have been shown to increase cognitive development over the preschool years; however, the effect is no longer evident after the patients start school. In summary, several recent interventions look promising in improving long-term outcomes for very preterm infants; however, their effects when implemented into usual clinical practice must be determined.