One-hundred twenty-nine very low-birthweight infants were treated in Newborn and Infant Care Department of Children's Memorial Health Institute between 1985 and 1994; 89 were taken to prospective neurodevelopmental care. The newborns were divided into two groups. Group I had 38 preterm infants born from 1985 to 1989 and followed up at 7 to 11 years of age. Group II had 51 very low-birthweight infants treated from 1990 to 1994 and followed up at 2 to 5 years of age. Complicated, multiple pregnancy, normal delivery, and extremely low birthweight were significantly more frequent in group II. Very low-birthweight infants were frequently born by cesarean section in severe asphyxia. Only four (7.8%) newborns received surfactant therapy. From 1990 to 1994, respiratory distress syndrome III and IV, and a longer respiratotherapy period were significantly more frequent. From 1985 to 1994, the frequency of sepsis, periventricular leukomalacia, and normal ultrasonography was constant. Intraventricular hemorrhage I, II, and IV were frequently present in the 1990s, and intraventricular hemorrhage III was frequent in the 1980s. Cerebral palsy was diagnosed in 11 (28.9%) children in group I and 18 (35.2%) in group II (not statistically different). Multiple and complicated pregnancy, cesarean section, severe asphyxia, and respiratory distress syndrome did not increase the risk of cerebral palsy in very low-birthweight infants. Periventricular leukomalacia has a more predictive value for cerebral palsy in these infants than did intraventricular hemorrhage.

Costs of neonatal care In the County of Vestfold 1980-84 (level I1 neonatal unit, 15% admitted from an unselected population averaging 2087 deliveries a year) were US$ 0.8 million a year (1984 exchange) (including costs of level I11 intensive care and trhnsportation), 1.6% of the county's total costs for hospital services. Costs per treated patient were on average US$ 2443. Salaries accounted for 82.2%, running expences 13.5%, and equipment 2%. Epidemiological data on neonatal mortality and handicaps showed a net gain of 25 infants with intact survival 1980-84 compared to 1970-79. Costs of treatment for these 25 patients (calculated as the 5 most expensive patients each year 1980-84 with intact survival) were on average US$ 28409, rehospitalization costs during the year after birth included (6.7% of the expenditures). Total lifetime income and taxes were calculated to 21.2 and 3.1 times treatment costs. Progress in neonatal care 1970-84 in our county has caused considerable medical gains, with a strongly positive economic benefit.

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