Australia Yearbook - 2001

392 Year Book Australia 2001
The special case of preterm births
and NICU
The increasing survival of very preterm infants
with more and more expensive neonatal intensive
care, but with worrying levels of disability, has
been debated and questioned internationally. In
the US this has been referred to as the perinatal
paradox: “the basic incongruity in American
perinatal care lies in our superb ability to care for
the individual patient and our dismal failure to
address the problems of the larger society”
(Rosenblatt 1989). The rates of death in smaller
and smaller preterm neonates have fallen since
the introduction of neonatal intensive care, and
the rates of motor disability such as severe
cerebral palsy have risen in the survivors
(Stanley, Blair et al. 2000). This is also
illustrated in graph C6.29.
Meanwhile the proportion of all births born
preterm has not changed, suggesting that
our efforts have been concentrated on
treating the sick preterm newborns rather
than on trying to increase the numbers born
at term. We must put as much effort into
researching the causal pathways to preterm
births and other causes of low birth weight as
we have into the biomedical research that
has had such a wonderful effect on their
survival.
C6.29 VERY LOW BIRTHWEIGHT(a), NEONATAL DEATH AND CEREBRAL PALSY RATES IN
WESTERN AUSTRALIA—1967 to 1996
Rate(b)
800
700
600
500
400
300
200
100
NND moving average(d)
CP moving average(d)
Rate(c)
80
70
60
50
40
30
20
10
0
1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995
0
(a) Birthweight less than 1,500g. (b) Neonatal death rates per 1,000 live births less than 1,500g. (c) Cerebral palsy rates per 1,000 live
births less than 1,500g. (d) 3-year moving averages; note that CP moving average rate for 1994 is derived from 2 years' data only.
Source: Cerebral Palsy Register, Institute for Child Research, Perth; Unpublished data.