Abstract
OBJECTIVE:To evaluate nursery survival of very low birth weight infants (VLBW) over time, born in the same large inner-city hospital with a predominantly Hispanic population.
METHODS:All liveborn VLBW infants weighing 500–1500 g at birth were included in four time periods of 2 years' duration during 1982 to 1995. Demographics were collected for the obstetric population. Clinical data were collected including maternal and infant perinatal factors. All infants were assigned a cause of death and infants dying with lethal anomalies were then excluded from further evaluations.
RESULTS:Overall survival improved progressively (p=0.0001) with dramatic improvement in survival of infants 500–750 g birth weight (BW) in period 4 (1994–1995). The number of lethal anomalies did not increase but accounted for a larger portion of deaths in period 4. Decreases in other causes of death over time reflected changes in perinatal care. Although the mothers were high-risk, none of the maternal factors evaluated showed any consistent effect on infant survival. Improved labor and delivery care was associated with improvement in Apgar scores, a decrease in intracranial hemorrhage/intraventricular hemorrhage as a cause of death and an improvement in survival between the first two periods. In spite of the increase in Cesarean sections for infants of 500–750 g BW and their improved survival in period 4, no clear advantage for Cesarean section could be demonstrated. The marked improvement seen in period 4 was associated with three changes in care: increased use of maternal steroids, administration of surfactant, and the use of newer ventilatory methods including high-frequency oscillatory ventilation. Although female gender has been reported to confer a protective influence for survival, this was not found in the final period. Black mothers comprised only about 2.5% of the total obstetric population but delivered approximately 10% of the VLBW infants. Despite the increased incidence of small for gestational age (SGA) among black infants, there were no differences in survival between blacks and Hispanics. Mean birth weight and gestational age in both survivors and nonsurvivors decreased significantly over the four time periods. In period 4, 50% survival occurred at a birth weight of 600–700 g and a gestational age of 23 weeks.
CONCLUSION:Nursery survival improved throughout the period of the study from 1982 to 1995 but especially during period 4 (1994–1995). Improved survival was associated with changes in both maternal and infant care. In infants of BW 500–750 g, gestational age rather than birth weight was more closely associated with survival.
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References
McCormick MC The contribution of low birth weight to infant mortality and childhood morbidity N Engl J Med 1985 312 82–90
Ehrenhaft PM, Wagner JL, Herdman RC Changing prognosis for very low birth weight infants Obstet Gynecol 1989 74 528–35
Worthington D, Davis LE, Grausg JP, Sobocinski K Factors influencing survival and morbidity with very low birth weight delivery Obstet Gynecol 1983 62 550–5
Teberg AJ, Settlage R, Hodgman JE, King Y, Aguilar T Maternal factors associated with delivery of infants with birthweight less than 2000 grams in a low socioeconomic population J Perinatol 1989 9 291–5
Cohen RS, Stevenson DK, Malachowski N, et al Favorable results of neonatal intensive care for very low-birth weight infants Pediatrics 1982 69 621–5
Horwood SP, Boyle MH, Torrance GW, Sinclar JC Mortality and morbidity of 500–1499 gram birth weight infants live-born to residents of defined geographic region before and after neonatal intensive care Pediatrics 1982 69 613–20
Teberg AJ, Hotrakitya S, Wu PYK, Yeh SY, Hoppenbrouwers T Factors affecting nursery survival of very low birth weight infants J Perinat Med 1987 15 297–306
Hein HA, Brown CV Neonatal mortality review: a basis for improving care Pediatrics 1981 68 504–09
Papile L, Bernstein R, Koffler H Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with BW <1500 grams J Pediatr 1978 92 529–34
Ballard J, Novack K, Driver M A simplified assessment of fetal maturation of newly born infants J Pediatr 1979 95 769–74
Lubchenco LO, Searls DT, Brazie JV Neonatal mortality rate: relation to birth weight and gestational age J Pediatr 1972 81 814–22
Dean AG, Dean JA, Coulombier D, et al Epi Info, Version 6: A Word-Processing, Database, and Statistics Program for Public Health on IBM-Compatible Microcomputers Atlanta, GA: Centers for Disease Control and Prevention. 1995
SAS Institute Inc SAS/STAT User's Guide, Version 6, 4th ed. 1 Cary, NC: SAS Institute Inc. 1989 943
James, SA Racial and ethnic differences in infant mortality and lowbirth weight. A psychosocial critique AEP 1993 2 11130–6
Gray PH, Hurley TM, Rogers YM, et al Survival and neonatal and neurodevelopmental outcome of 24–29 week gestation infants according to primary cause of preterm delivery Aust NZ J Obstet Gynecol 1997 37 161–8
Wolf EJ, Vintzileos AM, Rosenkrantz TS, et al Do survival and morbidity of very-low-birth-weight infants vary according to the primary pregnancy complication that results in preterm delivery? Am J Obstet Gynecol 1993 169 1233–9
Roth J, Resnick MB, Ariet M, et al Changes in survival patterns of very low birth weight infants from 1980 to 1993 Arch Pediatr Adolesc Med 1995 149 1311–7
Tyson JE, Younes N, Verter J, Wright LL Viability, morbidity, and resource use among newborns of 501- to 800-g birth weight JAMA 1996 276 1645–51
Yu VYH, Loke HL, Bajuk B, et al Prognosis for infants born at 23 to 28 weeks' gestation Br Med J 1986 293 1200445–7
Hack M, Horbar JD, Malloy MH, et al Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Network Pediatrics 1991 87 587–97
Allen MC, Donohue PK, Dusman AE The limit of viability — neonatal outcome of infants born at 22 to 25 weeks' gestation N Engl J Med 1993 329 1597–601
Fanaroff AA, Wright LL, Stevenson DK, et al Very-low-birth-weight outcomes of the National Institutes of Child Health and Human Development Neonatal Research Network, May 1991 through December 1992 Am J Obstet Gynecol 1995 173 1423–31
Hack M, Wright LL, Shankaron S, et al Very-low-birth-weight outcomes of the National Institute of Child Health and Human Development Neonatal Network, November 1989 to October 1990 Am J Obstet Gynecol 1995 172 457–64
O'Shea TM, Klinepeter KL, Goldstein DJ, Jackson BW, Dillard RG Survival and developmental disability in infants with birth weights of 501 to 800 grams, born between 1979–1994 Pediatrics 1997 100 982–6
Fuentes-Afflick E, Hessol NA, Perez-Stable EJ Maternal birthplace, ethnicity, and low birth weight in California Arch Pediatr Adolesc Med 1998 152 1105–12
Malloy MH, Onstad L, Wright E, and the National Institute of Child Health and Human Development Neonatal Research Network The effect of cesarean delivery on birth outcome in very low birth weight infants Obstet Gynecol 1991 77 498503
Palta M, Sadek M, Gabbert D, et al The relation of maternal complications to outcomes in very low birthweight infants in an era of changing neonatal care Am J Perinatol 1996 13 109–14
Hack M, Fanaroff AA Outcomes of extremely-low-birth-weight infants between 1982 and 1988 N Engl J Med 1989 321 1642–7
Teberg AJ, Pena I, Finello K, Aguilar T, Hodgman JE Prediction of neurodevelopmental outcome ininfants with and without bronchopulmonary dysplasia Am J Med Sci 1991 301 369–74
Taeusch HW, Supnet M Gestational age, birthweight, and neonatal mortality for extremely premature inner-city African-American and Latino infants J Natl Med Assoc 1994 86 297–302
Paul RH, Koh KE, Monfared AH Obstetric factors influencing outcome in infants weighing from 1,001 to 1,500 grams Am J Obstet Gynecol 1979 133 503–8
Richardson DK, Shah BL, Frantz ID, et al Perinatal risk and severity of illness in newborns at 6 neonatal intensive care units Am J Public Health 1999 89 511–6
Barrett JM, Boehm FH, Vaughn WK The effect of type of delivery on neonatal outcome in singleton infants of birth weight of 1,000 g or less JAMA 1983 250 625–9
Kitchen W, Ford GW, Doyle LW, et al Cesarean section or vaginal delivery at 24 to 28 weeks' gestation: comparison of survival and neonatal and two-year morbidity Obstet Gynecol 1985 66 149–57
Lagercrantz H, Katz-Salaman M, Forssberg H The Stockhold Neonatal Project: neonatal mortality and morbidity at the Children's Centre, Karolinska Hospital Acta Pediatr 1997 419 (suppl)11–5
Bottoms SF, Paul RH, Iams, et al Obstetric determinants of neonatal-survival: influence of willingness to perform cesarean delivery on survival of extremely low birth weight infants Am J Obstet Gynecol 1997 176 960–6
Jonas HA, Lumley JM The effect of mode of delivery on neonatal mortality in very low birthweight infants born in Victoria, Australia: caesarean section is associated with increased survival in breech-presenting, but not vertex-presenting, infants Paediatr Perinat Epidemiol 1997 11 181–99
Jobe AH, Mitchell BQ, Gunkel JH Beneficial effects of the combined use of prenatal corticosteroids and postnatal surfactant on preterm infants Am J Obstet Gynecol 1993 168 509–13
Corbet A, Bucciarelli R, Goldman S, et al. and the American Exosurf Pediatric Study Group 1 Decreased mortality rate among small premature multicenter controlled trial J Pediatr 1991 118 277–84
Horbar JD, Wright EC, Onstad L Decreasing mortality associated with the introduction of surfactant therapy; an observational study of neonates weighing 601 to 1300 grams at birth Pediatrics 1993 92 191–6
Piecuch RE, Leonard CH, Cooper BA, Sehring SA Outcome of extremely low birth weight infants (500–999 grams) over a 12 year period Pediatrics 1997 4 633–9
Gertsmann DR, Minton SD, Stoddard RA, et al The Provo multicenter early high-frequency oscillatory ventilation trial:improved pulmonary and clinical outcome in respiratory distress syndrome Pediatrics 1996 98 1044–57
Alexander JM, Gilstrap LC, Cox S, McIntire DM, Leveno KJ Clinical chorioamnionitis and the prognosis for very low birth weight infants Obstet Gynecol 1998 91 725–9
Barton L, Hodgman JE, Pavlova Z Causes of death in the extremely low birth weight infant Pediatrics 1999 103 446–51
Copper RL, Goldenberg RL, Creasy RK, et al A multicenter study of preterm birth weight and gestational age-specific neonatal mortality Am J Obstet Gynecol 1993 168 78–84
Spinillo A, Capuzzo E, Piazzi G, et al Significance of low birthweight for gestational age among very preterm infants Br J Obstet Gynecol 1997 104 668–73
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Teberg, A., Hodgman, J., Barton, L. et al. Nursery Survival for Infants of Birth Weight 500–1500 Grams During 1982–1995. J Perinatol 21, 97–106 (2001). https://doi.org/10.1038/sj.jp.7200480
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DOI: https://doi.org/10.1038/sj.jp.7200480
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