Abstract
Objective:
Ethical dilemmas continue regarding resuscitation versus comfort care in extremely preterm infants. Counseling parents and making decisions regarding the care of these neonates should be based on reliable, unbiased and representative data drawn from geographically defined populations. We reviewed survival and morbidity data for our population at the edge of viability.
Study Design:
A retrospective review of our perinatal database was carried out to identify all infants born alive and admitted to the neonatal intensive care unit (NICU) with BW⩽500 g between 1989 and 2009. Data from the initial hospital stay and follow-up at 24 months were collected.
Result:
Out of 22 672 NICU admissions, 273 were eligible: 212 neonates were reviewed after excluding infants with comfort care. BW ranged from 285 to 500 g (mean 448 g) and gestational age range 22 to 28 weeks (median 24 week). Sixty-one (28.8%) survived until discharge. Only 13.8% males survived compared with 39.2% females (P<0.05). Half (49%) were discharged with home oxygen/monitor. Fifty (82%) patients’ charts were available to review at the 24-month follow-up. Thirty-three percent of surviving infants had a normal neurodevelopmental assessment at 24 months. Forty-three percent had weight/head circumference<5th percentile at 24 months.
Conclusion:
About a third of neonates admitted to NICU with ⩽500 g BW survived, with 33% of those surviving, demonstrating age-appropriate development at a 24-month follow-up visit.
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References
Fanaroff AA, Hack M, Walsh MC . The NICHD neonatal research network: changes in practice and outcomes during the first 15 years. Semin Perinatol 2003; 27 (4): 281–287.
Horbar JD, Badger GJ, Carpenter JH, Fanaroff AA, Kilpatrick S, LaCorte M et al. Trends in mortality and morbidity for very low birth weight infants, 1991-1999. Pediatrics 2002; 110 (1 Pt 1): 143–151.
Ruegger C, Hegglin M, Adams M, Bucher HU . Population based trends in mortality, morbidity and treatment for very preterm- and very low birth weight infants over 12 years. BMC Pediatr 2012; 12: 17.
Doron MW, Veness-Meehan KA, Margolis LH, Holoman EM, Stiles AD . Delivery room resuscitation decisions for extremely premature infants. Pediatrics 1998; 102 (3 Pt 1): 574–582.
Kattwinkel J, Boyle R . Is the glass 10% empty or 90% full? Pediatrics 2004; 113 (6): 1846–1847.
Silverman WA . Compassion or opportunism? Pediatrics 2004; 113 (2): 402–403.
Streiner DL, Saigal S, Burrows E, Stoskopf B, Rosenbaum P . Attitudes of parents and health care professionals toward active treatment of extremely premature infants. Pediatrics 2001; 108 (1): 152–157.
Whitfield J, Charsha D, Hilton S, Ring A, Sprague P, Torvik I . Compassion or opportunism? Pediatrics 2004; 114 (5): 1371–1372.
Allen VM, Wilson RD, Cheung A . Pregnancy outcomes after assisted reproductive technology. J Obstet Gynaecol Can 2006; 28 (3): 220–250.
Henningsen AK, Pinborg A, Lidegaard O, Vestergaard C, Forman JL, Andersen AN . Perinatal outcome of singleton siblings born after assisted reproductive technology and spontaneous conception: Danish national sibling-cohort study. Fertil Steril 2011; 95 (3): 959–963.
Mathews TJ, MacDorman MF . Infant mortality statistics from the 2007 period linked birth/infant death data set. Natl Vital Stat Rep 2011; 59 (6): 1–30.
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 (22): 1597–1601.
Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR . Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. N Engl J Med 2000; 343 (6): 378–384.
De Leeuw R, Cuttini M, Nadai M, Berbik I, Hansen G, Kucinskas A et al. Treatment choices for extremely preterm infants: an international perspective. J Pediatr 2000; 137 (5): 608–616.
Oei J, Askie LM, Tobiansky R, Lui K . Attitudes of neonatal clinicians towards resuscitation of the extremely premature infant: an exploratory survey. J Paediatr Child Health 2000; 36 (4): 357–362.
Haumont D . Management of the neonate at the limits of viability. BJOG 2005; 112 (Suppl 1): 64–66.
Alexander GR, Slay Wingate M, Salihu H, Kirby RS . Fetal and neonatal mortality risks of multiple births. Obstet Gynecol Clin North Am 2005; 32 (1): 1–16, vii.
Lorenz JM, Paneth N . Treatment decisions for the extremely premature infant. J Pediatr 2000; 137 (5): 593–595.
The Victorian Infant Collaborative Study Group. Improvement of outcome for infants of birth weight under 1000 g. Arch Dis Child 1991; 66 (7 Spec No): 765–769.
Doyle LW . Evaluation of neonatal intensive care for extremely-low-birth-weight infants. Semin Fetal Neonatal Med 2006; 11 (2): 139–145.
Msall ME, Tremont MR . Measuring functional outcomes after prematurity: developmental impact of very low birth weight and extremely low birth weight status on childhood disability. Ment Retard Dev Disabil Res Rev 2002; 8 (4): 258–272.
Stephens BE, Vohr BR . Neurodevelopmental outcome of the premature infant. Pediatr Clin North Am 2009; 56 (3): 631–646, Table of Contents.
Fenton TR . A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr 2003; 3: 13.
Report of the Workshop on Bronchopulmonary Dysplasia. National Institutes of Health: Washington, DC, USA, 1979, NIH publication no. 80-1660.
Jobe AH, Bancalari E . Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (7): 1723–1729.
Papile LA, Burstein J, Burstein R, Koffler H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4): 529–534.
Committee for the classification of Retinopathy of Prematurity. An international classification of retinopathy of prematurity. Pediatrics 1984; 74 (1): 127–133.
Aaberg T, Ben-Sira I, Charles S, Clarkson J, Cohen BZ, Flynn J et al. An international classification of retinopathy of prematurity. II. The classification of retinal detachment. The International Committee for the Classification of the Late Stages of Retinopathy of Prematurity. Arch Ophthalmol 1987; 105 (7): 906–912.
Bayley N . Bayley Scales of Infant Development, 2nd edn, The Psychological Corporation: San Antonio, TX, USA, 1993.
Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B . Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 1997; 39 (4): 214–223.
Costeloe K, Hennessy E, Gibson AT, Marlow N, Wilkinson AR . The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 2000; 106 (4): 659–671.
Philip AG . Neonatal mortality rate: is further improvement possible? J Pediatr 1995; 126 (3): 427–433.
Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR et al. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007; 196 (2): 147 e141–e148.
Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (3): 443–456.
ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 101: ultrasonography in pregnancy. Obstet Gynecol 2009; 113 (2 Pt 1): 451–461.
Campbell S, Warsof SL, Little D, Cooper DJ . Routine ultrasound screening for the prediction of gestational age. Obstet Gynecol 1985; 65 (5): 613–620.
Kalish RB, Thaler HT, Chasen ST, Gupta M, Berman SJ, Rosenwaks Z et al. First- and second-trimester ultrasound assessment of gestational age. Am J Obstet Gynecol 2004; 191 (3): 975–978.
Jewell SE, Yip R . Increasing trends in plural births in the United States. Obstet Gynecol 1995; 85 (2): 229–232.
Society for Assisted Reproductive Technology, The American Fertility Society. Assisted reproductive technology in the United States and Canada: 1991 results from the Society for Assisted Reproductive Technology generated from the American Fertility Society Registry. Fertil Steril 1993; 59 (5): 956–962.
Bollen N, Camus M, Staessen C, Tournaye H, Devroey P, Van Steirteghem AC . The incidence of multiple pregnancy after in vitro fertilization and embryo transfer, gamete, or zygote intrafallopian transfer. Fertil Steril 1991; 55 (2): 314–318.
Kiely JL . The epidemiology of perinatal mortality in multiple births. Bull N Y Acad Med 1990; 66 (6): 618–637.
Kiely JL . Time trends in neonatal mortality among twins and singletons in New York City, 1968-1986. Acta Genet Med Gemellol (Roma) 1991; 40 (3-4): 303–309.
Acknowledgements
We thank Mrs Andrea Patters for her assistance in editing and preparation of the manuscript. No external funding was received for this study.
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Upadhyay, K., Pourcyrous, M., Dhanireddy, R. et al. Outcomes of neonates with birth weight⩽500 g: a 20-year experience. J Perinatol 35, 768–772 (2015). https://doi.org/10.1038/jp.2015.44
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DOI: https://doi.org/10.1038/jp.2015.44