Background Improvements in obstetric monitoring and the development of specialist centres dedicated to fetal medicine have led to improved survival of infants born <0.4th centile. There are limited data available on outcomes of these infants. This study describes health care utilisation rates of these infants in the first 2 years of life.

Method Prospective geographically based cohort study of VLBW infants from 1993 to 2002 Infants with a birth weight below 0.4th centile were identified using the UK growth charts. Infants were assessed at 2 years using prestructured forms. Data were analysed for hospital admissions and utilisation of community services.

Results 6% (153/2367) of VLBW infants were identified with a birth weight <0.4th centile. 128 (83.6%) survived to 2 year follow up. 72 (56.2%) required hospital admissions; median 2 visits (range 1–9). 17 (13.2%) needed 3 or more admissions. Over 10 years there were 1015 hospital admission days in the first 2 years of life. Although only accounting for 14% (72/516) of cohort needing admissions, infants <0.4th centile accounted for 41% of hospital admission days (1015/2494). 58% (74/128) had referrals made for one or more community services compared to an overall cohort referral rate of 24% (450/1850).

Conclusion Increased number of infants born <0.4th centile are surviving into childhood. This has resulted in increased hospital admissions and referrals to community services. Future planning within neonatal networks will need to take into account changing patterns in this subgroup to anticipate their greater need for education and health resources