Beyond the borderline: outcomes for inborn infants born at ≤500 grams (original) (raw)

Outcome of extremely-low-birthweight infants

BJOG: An International Journal of Obstetrics and Gynaecology, 1986

The overall 1-year survival rate of 261 infants born at 500 g-999 g over a 7-year period was 46%. The survival rate of the 220 inborn infants, corrected for birth defects, would have increased from 47% to 57% if delivery room deaths were excluded and to 62% if postneonatal deaths had also been ignored. Survival improved progressively with increasing 100 g weight groups. The disability rate in the 108 survivors who were at least 2 years old corrected for prematurity was 28% with little variation between the 100 g weight groups. There were no significant trends in annual perinatal mortality, 1-year survival and disability rate in survivors over the study period for the inborn population. The male infants had significantly lower normal-survival rate than the female infants. Small-for-gestational-age infants, comprising 11 % of the inborn group, had significantly better survival but a higher disability rate. Multiple births had significantly lower survival and normalsurvival rates than had singleton births. Infants whose mothers were transferred for delivery at the perinatal centre before onset of labour had a significantly better survival rate than those whose mothers had 'booked' and those who were transferred in labour.

The outcome of very low birth weight infants: past, present and future

The Indian Journal of Pediatrics, 1986

This article is on attempt to review the impact of neotnatal intensive care on mortality and childhood morbidity of VLBW infants. The evidence suggests that in the last decade there has been a significant reduction in neonatal mortality, particularly of the very tiny infants. However, although the data on morbidity is more difficult to interpret, there does not seem to have been a paraUel decline in the rate of neurological itnpairment in infants. The implication of this for the future is discussed.

Changing patterns of survival and outcome at 4 years of children who weighed 500–999 g at birth

Journal of Paediatrics and Child Health, 1995

Objective: To evaluate the impact of changing perinatal practices on survival rates and 4 year neurodevelopmental outcome for infants of birthweight 500-9999. Methodology: The study was a tertiary hospital-based prospective cohort study that compared survival, impairment and handicap rates between two eras, (era 2). All 348 live, inborn infants and 49 outborn infants of birthweight 500-9999 were prospectively enrolled in a study of survival and outcome. Rates of survival, neurodevelopmental impairment and functional handicap at 4 years were compared between eras. Perinatal risk factors for handicap were also compared between eras.

Survival of extremely low-birth-weight infants

South African Journal of Child Health, 2013

Objectives. Survival of extremely low-birth-weight (ELBW) infants in a resource-limited public hospital setting is still low in South Africa. is study aimed to establish the determinants of survival in this weight category of neonates, who, owing to limited intensive care facilities, were not mechanically ventilated. Design. A retrospective study in which patient data were retrieved from the departmental computer database. Setting. e neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa. Subjects. Neonates admitted at birth between January 2006 and December 2010 with birth weights of ≤900 g. Outcome measures. Survival at discharge was the major outcome. Maternal variables were age, parity, gravidity, antenatal care, antenatal steroids, place and mode of delivery and HIV status. Neonatal variables were gestational age (GA), birth weight (BW), gender, place of birth, hypothermia, resuscitation at birth, sepsis, necrotising enterocolitis, intraventricular haemorrhage, jaundice, nasal continuous positive airway pressure (NCPAP) with or without surfactant, and Apgar scores. Results. A total of 382 neonates were included in the study. Overall survival was 26.5%. e main causes of death, as per the Perinatal Problem Identi cation Programme (PPIP) classi cation, were extreme multi-organ immaturity and respiratory distress syndrome. e main determinants of survival were BW (odds ratio (OR) 0.994; 95% con dence interval (CI) 0.991 -0.997) and GA (OR 0.827; 95% CI 0.743 -0.919). Overall the rate of NCPAP use was 15.5%, and NCPAP was not associated with improved survival. Conclusion. Survival of ELBW infants is low. BW and GA were the strongest predictors of survival. E ective steps are required to avoid extreme prematurity, encourage antenatal care, and provide antenatal steroids when preterm birth is anticipated. S Afr J CH 2013;7(1):13-16.

Outcomes of extremely low-birth-weight infants between 500 and 750 g

American Journal of Obstetrics and Gynecology, 2000

Objective: The purpose of this study was to describe morbidity, mortality, and developmental outcomes among extremely low-birth-weight infants (500-750 g). Study Design: This retrospective cohort study included 167 live-born infants born at Long Beach Memorial Medical Center between January 1990 and December 1995. Results: Mortality rates were 86% among infants <600 g and 44% among those ≥600 g, and the rate decreased with increasing gestational age. The absence of chorioamnionitis (P = .01) and the use of antepartum corticosteroids (P < .0001) or neonatal surfactant (P = .0001) were associated with survival. Sixty-four percent of studied infants had respiratory distress syndrome, and 17% had grade III or IV intraventricular hemorrhage. Among the 63 survivors 57% were tested at 30 months of corrected age with the Bayley Scales of Infant Development. Mild or significant delays were seen on the mental development index in 68% of these cases and on the psychomotor development index in 58% of cases. Conclusion: Morbidity and mortality rates and the rate of developmental delay among infants with birth weights between 500 and 750 g were significant. (Am J Obstet Gynecol 2000;182:1113-6.)

Outcome in infants of birth weight 500 to 999 g: A continuing regional study of 5-year-old survivors

Journal of Pediatrics, 1987

During 1979 and 1980, 351 infants of birth weight 500 to 999 g were born in the State of Victoria: 89 (25.4%) survived to the age of 2 years corrected for prematurity, and 83 were fully assessed by a multidisciplinary team; partial data were obtained on the remainder. At the age of 5 years, corrected for prematurity, 85/89 (96%) were evaluated by a multidisciplinary team, although not all children could be fully evaluated by the psychologists. Reports were available for another three children; one child was untraced. Of the survivors able to be classified at 5 years, 59/82 (72%) had no functional handicap. Functional handicaps was severe in 16 (19%), moderate in four (5%), and mild in three (4%). Functional handicaps were present in 50% (8/16) of outborn survivors compared with the 23% (15/66) for the inborn survivors (P = 0.02). Cerebral palsy was diagnosed in eight children at 5 years and in 12 children at 2 years. The diagnosis was stable for the children not ambulant at 2 years; five of seven 2-year-old children with mild cerebral palsy had "outgrown" the diagnosis by 5 years, but ataxic cerebral palsy was not identified in one child until 5 years. Six children were blind; four had severe sensorineural or mixed deafness, one more than at 2 years. Of 82 children assessed according to identical criteria for functional handicap at both 2 and 5 years, 52 (63%) remained in the same category at 5 years, three (4%) were judged to be more severely handicapped, and 27 (33%) were less severely handicapped. The 2-year evaluation of extremely low birth weight children often proved to be unduly pessimistic, for many showed improvement or recovery from functional handicaps and impairments by 5 years of age. (J PEDIAI"R 1987;111:761-6) With modern intensive perinatal care, the survival prospects for ELBW infants (birth weight 500 to 999 g) have improved, up to 65% in one hospital-based report? However, in community-based studies the survival prospects are ELBW WPPSI

Neurodevelopmental outcomes of extreme-low-birth-weight infants born between 2001 and 2002

Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine, 2008

To report the neurodevelopmental outcomes of extreme-low-birth-weight survivors. Multicentre cohort study. Three regional hospitals in Hong Kong. Surviving extreme-low-birth-weight infants born in 2001 and 2002 underwent neurodevelopmental, neurosensory, and functional assessment under the High Risk Follow-up Program in three Child Assessment Centres. Demographic characteristics, neonatal diagnoses and treatment given, as well as neurodevelopmental outcomes were prospectively collected, and possible maternal and neonatal risk factors for major disability evaluated. Of 81 extreme-low-birth-weight infants, 49 had undergone evaluation under the High Risk Follow-up Program. Their mean gestational age was 26.2 (standard deviation, 1.8) weeks and mean birth weight was 789 g (standard deviation, 125 g). Seventeen infants were less than 750 g and 32 were between 751 and 999 g. The rates of cerebral palsy, intellectual impairment, hearing deficit, and visual impairment were 12%, 16%, 4%, and...

Developmental outcome of very low birth weight infants in a developing country

BMC Pediatrics, 2012

Background: Advances in neonatal care allow survival of extremely premature infants, who are at risk of handicap. Neurodevelopmental follow up of these infants is an essential part of ongoing evaluation of neonatal care. The neonatal care in resource limited developing countries is very different to that in first world settings. Follow up data from developing countries is essential; it is not appropriate to extrapolate data from units in developed countries. This study provides follow up data on a population of very low birth weight (VLBW) infants in Johannesburg, South Africa. Methods: The study sample included all VLBW infants born between 01/06/2006 and 28/02/2007 and discharged from the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Bayley Scales of Infant and Toddler Development Version 111 (BSID) 111 were done to assess development. Regression analysis was done to determine factors associated with poor outcome.