Beyond the borderline: Outcomes for inborn infants born at ≤500 grams

Keir, Amy; McPhee, Andrew J; Wilkinson, Dominic

doi:10.1111/jpc.12414

Cited by 35 publications

(51 citation statements)

References 31 publications

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“…For example, Vohr et al 28 26 Bayley Scales of Infant Development-II, 28 Kaufmann Assessment Battery for Children, 29 or an unknown scale. 30 This heterogeneity has limited the direct comparison of data on neurodevelopmental outcomes across studies. The variability may also be related to population coverage (single institute versus nationwide cohort), health insurance system (universal versus private), and socioeconomic conditions.…”

Section: Discussionmentioning

confidence: 99%

Neurodevelopmental Outcomes in Infants With Birth Weight ≤500 g at 3 Years of Age

et al. 2018

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OBJECTIVES: To determine neurodevelopmental outcomes at 3 years of age in children born with a birth weight (BW) of ≤500 g. METHODS: Infants who were born with a BW of ≤500 g from 2003 to 2012 in the Neonatal Research Network of Japan and survived to discharge from the NICU were eligible in this study. The study population consisted of 460 children (56.7% of 811 surviving infants) who were evaluated at 36 to 42 months of age. Neurodevelopmental impairment (NDI) was defined as having cerebral palsy, visual impairment, hearing impairment, or a developmental quotient score of <70. RESULTS: The overall proportion of NDI was 59.1% (95% confidence interval [CI]: 54.6%–63.5%). The trend revealed no significant change during the study period. In a multivariate modified Poisson regression analysis, NDI was associated with severe intraventricular hemorrhage (adjusted risk ratio [RR]: 1.42; 95% CI: 1.19–1.68; P < .01), cystic periventricular leukomalacia (adjusted RR: 1.40; 95% CI: 1.13–1.73; P < .01), severe necrotizing enterocolitis (adjusted RR: 1.31; 95% CI: 1.07–1.60; P < .01), surgical ligation for patent ductus arteriosus (adjusted RR: 1.29; 95% CI: 1.09–1.54; P < .01), and male sex (adjusted RR: 1.19; 95% CI: 1.01–2.40; P = .04). CONCLUSIONS: This cohort showed that neurodevelopmental outcomes of infants with a BW of ≤500 g have not improved from 2003 to 2012. Multivariate analysis revealed that severe intracranial hemorrhage and cystic periventricular leukomalacia were the strongest risk factors for NDIs. Our data suggested that measures aimed at reducing neurologic morbidities will be important for improving outcomes of infants with a BW of ≤500 g.

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Section: Discussionmentioning

confidence: 99%

Neurodevelopmental Outcomes in Infants With Birth Weight ≤500 g at 3 Years of Age

et al. 2018

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“…We have shown that the survival to one year for babies born weighing ≤500 g in the North East and North Cumbria is poor, at just 11%. There is a paucity of data in the literature about this group of smallest babies and reported survival rates vary from 6% to 60% . The strengths of this study are that it is based on a well‐defined geographical population and ascertained mortality outcome to a year, over a long period.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of infants with a birthweight less than or equal to 500 g in Northern England: 15 years experience

et al. 2017

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“…Surfactant therapy, improved ventilators and ventilation strategies, improved surgical techniques and parenteral feeding have enabled the survival of vulnerable babies [1, 2]. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context.…”

Section: Introductionmentioning

confidence: 99%

Palliative care in the neonatal unit: neonatal nursing staff perceptions of facilitators and barriers in a regional tertiary nursery

Kilcullen

Ireland

2017

BMC Palliat Care

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BackgroundNeonatology has made significant advances in the last 30 years. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. Previous research has focused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed while also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators and barriers to delivery of palliative care and also the impact of the regional location of the unit.MethodsThe study was conducted at the Townsville Hospital, which is the only regional tertiary neonatal unit in Australia. Semi-structured interviews were conducted with a purposive sample of eight neonatal nurses. Thematic analysis of the data was conducted within a phenomenological framework.ResultsSix themes emerged regarding family support and staff factors that were perceived to support the provision of palliative care of a high quality. Staff factors included leadership, clinical knowledge, and morals, values, and beliefs. Family support factors included emotional support, communication, and practices within the unit. Five themes emerged from the data that were perceived to be barriers to providing quality palliative care. Staff perceived education, lack of privacy, isolation, staff characteristics and systemic (policy, and procedure) factors to impact upon palliative care provision. The regional location of the unit also presented unique facilitators and barriers to care.ConclusionsThis study identified and explored facilitators and barriers in the delivery of quality palliative care for neonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and amplifies facilitating factors while identified barriers are addressed or minimized, would be successful in supporting quality palliative care provision in the neonatal care setting. Study findings will be used to inform clinical education and practice.

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Beyond the borderline: Outcomes for inborn infants born at ≤500 grams

Abstract: There was a high risk of death or impairment in this cohort of infants. Survival was rare for AGA infants weighing ≤500 g at birth. Our study provides an evidence base to assist counselling and decision-making.

Cited by 35 publications

References 31 publications

Neurodevelopmental Outcomes in Infants With Birth Weight ≤500 g at 3 Years of Age

Neurodevelopmental Outcomes in Infants With Birth Weight ≤500 g at 3 Years of Age

Outcomes of infants with a birthweight less than or equal to 500 g in Northern England: 15 years experience

Palliative care in the neonatal unit: neonatal nursing staff perceptions of facilitators and barriers in a regional tertiary nursery

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