Outcome of infants born at 21–28 weeks' gestation in an inner-city hospital over an eight-year period (original) (raw)
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American Journal of Obstetrics and Gynecology, 1992
OBJECTIVES: This study details the incidence, by gestational age and birth weight, of specific neonatal morbidities in singleton neonates without major congenital anomalies. STUDY DESIGN: Data were prospectively collected on all deliveries at five tertiary centers in the United States during the years 1983 through 1986. Pregnancies were meticulously dated and the gestational ages of the neonates at delivery were confirmed by Dubowitz score. RESULTS: The incidence of respiratory distress syndrome gradually decreases with increasing gestational age until 36 weeks. A marked decrease in the incidence of necrotizing enterocolitis, patent ductus arteriosus, intraventricular hemorrhage, and sepsis occurs after 32 completed weeks. The number of days of mechanical ventilation for respiratory distress syndrome and newborn stay in the tertiary care facility also were significantly reduced after 32 weeks.
The Extremely Low Birth Weight Infant
Neonatology. Physiology and management of the …, 1999
Extremely low birth weight infants (ELBW) are defined by birth weight of less than 1000 g and are frequently born at 27 weeks' gestation (GW) or younger. The neonatologists' efforts focused on improvement of intact survival rate, especially for those born at the frontiers of viability at 22/23 GW. Survival rates of >80% for the advanced gestations and > 50% for 23-24 GW have been reported. Higher gestational age and birth weight, female gender, better maternal education, and white race have been recognized as significant predictors of decreased morbidity in ELBW infants. Although the mortality rate has significantly contracted for this group with improved technology and better understanding of pathophysiology, the proportion of surviving infants without sequelae, has not improved as noticeably. We review the short and long-term morbidities in ELBW infants and compare own and literature data. We analyze some of the specific immediate problems for this group such as: respiratory problems, infection, thermoregulation, impaired glucose homeostasis and disturbed cardiovascular and excretory functions as well as late morbidities such as bronchopulmonary dysplasia, late-onset infections, central nervous system occurrences, retinopathy and anemia of prematurity. We also deal with preventive and therapeutic strategies for improved outcome in this sensitive group of patients.
Morbidity and mortality in preterm infants less than 29 weeks of gestational age
DOAJ (DOAJ: Directory of Open Access Journals), 2019
Background: Preterm birth is certainly a public health problem. Aside from being an important cause of mortality, prematurity increases the risk of serious lifetime disabilities. Objective: To assess the overall survival, causes of death and neonatal morbidities associated with prematurity of newborns less than 29 weeks of gestational age (GA). Methods: Retrospective study including all preterm infants less than 29 weeks of GA admitted to the level III NICU at Centro Hospital São João in Porto, Portugal, between January 1st 2005 and December 31st 2016. Newborns were grouped in three groups according to their GA: G23 +0-24 +6 , G25 +0-26 +6 , G27 +0-28 +6. Results: In this 12-year-period, 160 preterm neonates less than 29 weeks of GA admitted to this NICU met our inclusion criteria. Overall deaths were 60 (37.5%), variating between 25 (92.6%) in the G23 +0-24 +6 , 23 (46%) in the G25 +0-26 +6 and 12 (14.5%) in the G27 +0-28 +6. Early neonatal mortality was 20.6% and the leading causes of death were intraventricular hemorrhage (IVH) and sepsis. Among survivors, 41% had bronchopulmonary dysplasia (BPD), 69% developed late sepsis, 56% retinopathy of prematurity (ROP), 44% IVH and 10% cystic periventricular leukomalacia (cPVL). Conclusions: Mortality rates in this preterm group were high in spite of all the technological and scientific advances. Pulmonary conditions (respiratory distress syndrome and BPD), sepsis and neurologic outcomes (ROP, IVH and cPVL) were still major causes of morbidity. In line with other series, the limit of viability in this cohort of preterm infants is 25 weeks of GA. Prenatal, perinatal and postnatal care still all have a long road ahead, especially when it comes to these "gray zone" newborns.
Scientific Reports, 2020
To investigate mortality in periviable neonates ≤23 weeks gestational age and calculate its impact on overall neonatal mortality rate over a 12-year period (1998–2009). Verify if periviable mortality decreased in the period (2010–2015). Retrospective review. Neonatal mortality rate per 1000 live births was 11.4. Three hundred forty-nine live birth infants weighed ≤500 g and 336 died. Their proportion to the total neonatal mortality rate was 48.6%; out of 298 periviables 146 (43%) were ≤20 weeks gestational age. In 269 (80%) we could not determine the cause of death. Two hundred ninety-seven neonates (88.3%) died in the delivery room. Sixteen (5%) had an autopsy. Neonatal mortality rate from periviability was 96.2% and constituted half of the overall rate in the period (1998–2009). There was not significant reduction of periviable mortality between 2010 and 2015. Current live birth definition and a reporting system that considers a 100 g periviable live birth infant as a neonatal dea...
BMJ, 2008
Objective To assess changes in survival for infants born before 26 completed weeks of gestation. Design Prospective cohort study in a geographically defined population. Setting Former Trent health region of the United Kingdom. Subjects All infants born at 22+0 to 25+6 weeks' gestation to mothers living in the region. Terminations were excluded but all other births of babies alive at the onset of labour or the delivery process were included. Main outcome measures Outcome for all infants was categorised as stillbirth, death without admission to neonatal intensivecare, death before discharge from neonatal intensivecare, and survival to discharge home in two time periods: 1994-9 and 2000-5 inclusive. Results The proportion of infants dying in delivery rooms was similar in the two periods, but a significant improvement was seen in the number of infants surviving to discharge (P<0.001). Of 497 infants admitted to neonatal intensive care in 2000-5, 236 (47%) survived to discharge compared with 174/490 (36%) in 1994. These changes were attributable to substantial improvements in the survival of infants born at 24 and 25 weeks. During the 12 years of the study none of the 150 infants born at 22 weeks' gestation survived. Of the infants born at 23 weeks who were admitted to intensive care, there was no significant improvement in survival to discharge in 2000-5 (12/65 (18%) in 2000-5 v 15/81 (19%) in 1994-9). Conclusions Survival of infants born at 24 and 25 weeks of gestation has significantly increased. Although over half the cohort of infants born at 23 weeks wasadmitted to neonatalintensive care, there was no improvement in survival at this gestation. Care for infants born at 22 weeks remained unsuccessful.
Changing Survival Rate of Infants Born Before 26 Gestational Weeks: Single-centre study
Sultan Qaboos University Medical Journal, 2015
Objectives: This study aimed to evaluate the changing survival rate and morbidities among infants born before 26 gestational weeks at the Sultan Qaboos University Hospital (SQUH) in Muscat, Oman. Methods: This retrospective study assessed the mortality and morbidities of all premature infants born alive at 23-26 gestational weeks at SQUH between June 2006 and May 2013. Infants referred to SQUH within 72 hours of birth during this period were also included. Electronic records were reviewed for gestational age, gender, birth weight, maternal age, mode and place of delivery, antenatal steroid administration, morbidity and outcome. The survival rate was calculated and findings were then compared with those of a previous study conducted in the same hospital from 1991 to 1998. Rates of major morbidities were also calculated. Results: A total of 81 infants between 23-26 gestational weeks were admitted to the neonatal unit during the study period. Of these, 58.0% were male and 42.0% were female. Median gestational age was 25 weeks and mean birth weight was 770 ± 150 g. Of the 81 infants, 49 survived. The overall survival rate was 60.5% compared to 41% reported in the previous study. Respiratory distress syndrome (100.0%), retinopathy of prematurity (51.9%), bronchopulmonary dysplasia (34.6%), intraventricular haemorrhage (30.9%) and patent ductus arteriosus (28.4%) were the most common morbidities. Conclusion: The overall survival rate of infants between 23-26 gestational weeks during the study period had significantly improved in comparison to that found at the same hospital from 1991 to 1998. There is a need for the long-term neurodevelopmental follow-up of premature infants.
Morbidity in early term and full-term neonates in a NICU
Journal of Pediatric and Neonatal Individualized Medicine, 2018
INTRODUCTION Term neonates (37-41 weeks' gestation) have been considered as a homogeneous group – regarding morbidity – when compared to preterm and post term neonates. But there is substantial evidence suggesting that significant differences exist in the outcomes of infants delivered within this 5-week interval. As morbidity appears to be greater for neonates born at 37-38+6/7 weeks of gestation than for those born at 39-41 weeks, the adoption of the ACOG-recommended designations – “early term” for neonates born at 37 to 38 completed weeks' gestation and “full term” for those born at 39 to 40 weeks' gestation – is considered necessary. AIM To assess morbidity in early term neonates (ET) compared to full term neonates (FT). METHODS A retrospective study was conducted, with data from our NICU's electronic archives, concerning 124 term neonates hospitalized in the NICU during 2016. The study population was divided into two groups: ET and FT neonates. The type of delivery, body temperature on admission, the incidence of RDS, asphyxia/stress, septicemia, mechanical ventilation/oxygen therapy, the day of full enteral feeding and the duration of hospitalization were recorded. RESULTS Statistically significant differences were noticed, regarding the type of delivery, with ET neonates (n = 68) being born mainly via caesarean section (CS) (77.9%), and among them 71.2{\%} via elective CS. In ET neonates, an increased incidence of RDS, prolongation of mechanical ventilationoxygen therapy-hospitalization stay, and delay of full enteral feeding (p value < 0.05) were observed. On the other hand, FT neonates (56) showed an increased incidence of asphyxia/stress (p value = 0.016) and septicemia (p value = 0.27). CONCLUSIONS According to our study results, there was an increased morbidity of ET neonates, a finding consistent with literature data. We believe that our findings confirm furthermore the need to reconsider the optimal timing for delivery in uncomplicated pregnancies.
Mortality of full-term infants during the first month of life in a tertiary care hospital
Journal of Perinatology, 2007
Objective: The neonatal mortality rate is disproportionately influenced by preterm infants and does not reflect the rate in full-term infants. Our objectives were to estimate the full-term neonatal mortality rate and to identify causes of death in full-term infants during the first month of life. Study Design: A retrospective study of full-term infant deaths during a 6-year period from 2000 to 2005, in a tertiary medical center. Result: During the study period there were 44 703 full-term births and 31 deaths, representing a mortality rate of 0.69 per 1000 live births. The main cause of death was congenital anomalies (64.5%), specifically cardiac anomalies. Other causes were chromosomal anomalies or syndromes (12.9%), labor complications (12.9%), infections (3.2%), congenital diseases (3.2%) and metabolic disorders (3.2%). Conclusion: The mortality rate of full-term infants may be lower than previous estimates. Efforts aimed at decreasing mortality among full-term infants should focus on prenatal diagnosis.
Outcome of extremely preterm infants
Objective. To determine mortality and morbidity at discharge from the hospital of a large population-based cohort of infants who were born at <26 weeks' gestation.