Abstract 1504 Poster Session III, Monday, 5/3 (poster 32)

Improvements in OB and neonatal care have lowered the limit of viability for ELBW infants. The purpose of this study was to describe the epidemiologic characteristics and short-term outcome of ELBW infants (401-700g). Data from the NICHD Neonatal Research Network's generic database were analyzed. Between 1993 and 1997, 2808 infants ≤700g were cared for at Network Centers. Of these, 28% were not intubated in the delivery room. The following analyses are based on the 2032 infants (72%) who were intubated and offered intensive care (401-500g, 40%; 501-600g, 68%; 601-700g, 87%). Overall, 89% of mothers received prenatal care, 51% antenatal steroids, 55% antenatal antibiotics, and 44% infants were delivered via C-section. 53% of infants were black, 34% white, 11% Hispanic, and 54% were female. Twenty percent of this cohort received resuscitation drugs in the DR, 87% received surfactant, and 32% prophylactic indocin. Initial diagnoses included RDS (74%) and early onset sepsis (3%). Survival of these ELBW infants increased with increasing BW and GA. Overall, 53% survived to 120 days, transfer or discharge (status). There was no significant effect of race on survival, but female infants had significantly improved survival at each weight group. Infants who received drugs in the DR were significantly more likely to die. Among those who died before status, 35% deaths occurred on day 1 and 46% by day 3; almost half of all deaths occurred after the first week of life. Between 1993-94 and 1996-97, there was only slight improvement in survival at each weight group (401-500g, 22 vs. 32%, NS; 501-600g, 42 vs. 42%, NS; 601-700g, 60 vs. 66%, p<0.06). Important short-term medical morbidities among infants who survived to status are presented in the Table. In conclusion, infants ≤700g suffer significant short-term morbidities that may adversely affect their long-term outcome. Extremely immature infants who receive resuscitation drugs in the DR have high rates of early mortality. Whether or not to use DR resuscitation drugs in this extremely high risk population remains an important question.

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