Early Death, Morbidity, and Need of Treatment Among Extremely Premature Infants

Markestad, Trond; Kaaresen, Per Ivar; Rønnestad, Arild; Reigstad, Hallvard; Lossius, Kristin; Medbø, Sverre; Zanussi, Gro; Engelund, Inger Elise; Skjærven, Rolv; Irgens, Lorentz M.

doi:10.1542/peds.2004-1482

Cited by 309 publications

(270 citation statements)

References 29 publications

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“…18 In more recent studies, none of the infants born at <23 weeks were reported to survive to discharge from the NICU. [19][20] It appears that these findings, and perhaps the practicing neonatologists' own experiences, have influenced the approach to the management provided in the delivery room to the smallest and most immature neonates, as a recent survey of academic and private neonatologists in the United States has found that only 4% of the participants would resuscitate a neonate at 23 weeks' gestation with a birth weight of <500 g. 12 It further states that 57% of the responders would provide comfort care only, and 36% would defer the decision to parental wishes for these extremely immature infants. 12 Data from the Vermont-Oxford Network's database covering a 5-year period at the end of the past decade reveal that survival to discharge among 4172 infants with a birth weight between 401 and 500 g and a gestational age of 23.3 ± 2.1 weeks was only 17%.…”

Section: Resultsmentioning

confidence: 99%

Limits of viability: definition of the gray zone

2008

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Introduction: As survival and long-term morbidity of very preterm infants have improved over the past decade, the limits of infant viability, the level of maturity below which survival and/or acceptable neurodevelopmental outcome are extremely unlikely, have also decreased. Study Design:In an effort to define the current limits of infant viability, the data in the literature on survival and long-term neurodevelopmental outcome in very preterm neonates have been reviewed. Result:The gestational age and birth weight below which infants are too immature to survive, and thus provision of intensive care is unreasonable, appears to be at <23 weeks and <500 g, respectively. Infants born at X25 weeks' gestation and with a birth weight of X600 g are mature enough to warrant initiation of intensive care, as the majority of these patients survive, and at least 50% do so without severe long-term disabilities. Finally, for infants born between 23 0/7 and 24 6/7 weeks' gestation and with a birth weight of 500 to 599 g, survival and outcome are extremely uncertain. For these infants born in the so-called 'gray zone' of infant viability, the line between patient autonomy and medical futility is blurred, and medical decision-making becomes even more complex and needs to embrace careful consideration of several factors. These factors include appraisal of prenatal data and the information obtained during consultations with the parents before delivery; evaluation of the patient's gestational age, birth weight and clinical condition upon delivery; ongoing reassessment of the patient's response to resuscitation and intensive care and continued involvement of the parents in the decision-making process after delivery.Conclusion: Based on these findings an algorithm is offered for consideration for neonatologists managing infants born in the 'gray zone' of infant viability. However, caution must be exercised when one considers incorporating this guideline into clinical practice because the algorithm is based on the analysis of the findings in the literature and the authors' experience rather than direct evidence.

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Section: Resultsmentioning

confidence: 99%

Limits of viability: definition of the gray zone

2008

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“…Previous studies have noted a wide range of survival rates for all births (including stillbirths) at this gestation, ranging from 0% to 37%. [5][6][7][9][10][11][12]14,[17][18][19]36,37 Some studies present survival rates for live births only, ranging from 0% to 53%. 5,7,10,11,14,[16][17][18]20,36,37,47 Other studies include only infants admitted to the NICU, with survival rates ranging from 0% to 66%.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][9][10][11][12]14,[17][18][19]36,37 Some studies present survival rates for live births only, ranging from 0% to 53%. 5,7,10,11,14,[16][17][18]20,36,37,47 Other studies include only infants admitted to the NICU, with survival rates ranging from 0% to 66%. 4,9,[11][12][13][14][15]17,18,20,21,23,24,34 Previous Canadian studies that did not include stillbirth noted survival rates in infants admitted to the NICU of 35.2% to 41.7%.…”

Section: Discussionmentioning

confidence: 99%

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Maternal and Perinatal Outcomes of Pregnancies Delivered at 23 Weeks’ Gestation

Crane

Magee

Lee

et al. 2015

Journal of Obstetrics and Gynaecology Canada

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Objective: To evaluate the maternal and perinatal outcomes of pregnancies delivered at 23+0 to 23+6 weeks' gestation .Methods: This prospective cohort study included women in the Canadian Perinatal Network who were admitted to one of 16 Canadian tertiary perinatal units between August 1, 2005, and March 31, 2011, and who delivered at 23+0 to 23+6 weeks' gestation . Women were included in the network if they were admitted with spontaneous preterm labour with contractions, a short cervix without contractions, prolapsing membranes with membranes at or beyond the external os or a dilated cervix, preterm premature rupture of membranes, intrauterine growth restriction, gestational hypertension, or antepartum hemorrhage . Maternal outcomes included Caesarean section, placental abruption, and serious complication . Perinatal outcomes were mortality and serious morbidity .Results: A total of 248 women and 287 infants were included in the study . The rate of Caesarean section was 10 .5% (26/248) and 40 .3% of women (100/248) had a serious complication, the most common being chorioamnionitis (38 .6%), followed by blood transfusion (4 .5% (25/25) . Two subgroup analyses were performed: in one, antepartum stillbirths were excluded, and in the other only centres that indicated they offered fetal monitoring at 23 weeks' gestation were included and antepartum stillbirths were excluded . In each of these, perinatal outcomes similar to the overall group were found . Conclusion:Pregnant women delivering at 23 weeks' gestation are at risk of morbidity . Their infants have high rates of serious morbidity and mortality . Further research is needed to identify strategies and forms of management that not only increase perinatal survival but also reduce morbidities in these extremely low gestational age infants and reduce maternal morbidity .

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“…5,[10][11][12] Survival rates among preterm babies born with GA of 27-28 weeks have been reported to be as high as 90%, although the numbers vary widely across countries. 13 Studies suggest that the incidence and severity of ROP show an inverse relationship with BW and GA, 14 with few cases diagnosed in babies weighing over 1500 g or babies whose GA was 432 weeks at birth. Severe ROP has a higher incidence among infants born with GA o28 weeks or BW o1000 g. However, severe ROP is also reported in babies born at 34-35 weeks with BW 1500 g or more, 15 especially when postnatal systemic complications occur, as shown in studies in India, China, and Lithuania.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for retinopathy of prematurity in very low and in extremely low birth weight infants in a unit-based approach in southern Brazil

Filho

Eckert

Procianoy

et al. 2007

Eye

101

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Aims To analyse the incidence and risk factors for retinopathy of prematurity (ROP) and survival rates among extremely low birth weight (ELBW) and very low birth weight (VLBW) preterm infants. Methods A prospective cohort study of 352 infants admitted at a teaching hospital, Hospital de Clinicas de Porto Alegre, Brazil, between October 2002 and December 2006, was screened for ROP. The ELBW group comprised infants whose birth weight (BW) was p1000 g and the VLBW group comprised those infants whose BW were 41000 g and p1500 g. Perinatal risk factors for ROP were assessed using univariate and multivariate analysis. Results Of the 352 neonates screened, 88 were ELBW babies. Survival rates among ELBW and VLBW were 47.8 and 88.7%, respectively. ROP affected 48.9% of ELBW infants and 18.2% of VLBW babies. Threshold disease occurred in 21 patients, 15 of whom were born weighing o1000 g. Only 2.3% of the neonates born with more than 1000 g developed treatable disease. Univariate analysis showed that gestational age (GA), BW, use of indomethacin and erythropoietin, blood transfusions, and intraventricular haemorrhage were associated with ROP. After logistic regression, the most important adjusted risk factors were BW (OR: 1.002;95% CI: 1.001-1.003; P ¼ 0.003), GA (OR: 1.254;95% CI: 1.082-1.455; P ¼ 0.003), and use of erythropoietin (OR: 2.486;95% CI: 1.182-5.231; P ¼ 0.016). ConclusionThis study showed reduced survival rates, high incidence of ROP, and a greater need of treatment among ELBW infants as compared to VLBW babies admitted in this institution.

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Early Death, Morbidity, and Need of Treatment Among Extremely Premature Infants

Cited by 309 publications

References 29 publications

Limits of viability: definition of the gray zone

Limits of viability: definition of the gray zone

Maternal and Perinatal Outcomes of Pregnancies Delivered at 23 Weeks’ Gestation

Incidence and risk factors for retinopathy of prematurity in very low and in extremely low birth weight infants in a unit-based approach in southern Brazil

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