Prediction of survival for preterm births by weight and gestational age: retrospective population based study

Draper, Elizabeth S; Manktelow, Bradley N; Field, David; James, David

doi:10.1136/bmj.319.7217.1093

Cited by 212 publications

(127 citation statements)

References 15 publications

(16 reference statements)

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“…[1][2][3][4][5][6][7][8][9] The gestational age at which at least half of the infants survive has decreased from 30 to 31 weeks in the 1960s to 23 to 24 weeks during this decade. 8 The increase in survival of the smallest, most vulnerable infants represents an enormous improvement in our ability to deliver prenatal, perinatal and postnatal care to the pregnant woman and her offspring and could not have been achieved without close collaboration between perinatology and neonatology and advances in our understanding of fetal, transitional and neonatal physiology and pathophysiology.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

Limits of viability: definition of the gray zone

2008

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“…21 We therefore used 6 published reports from matching time periods and from populations with similar ethnic distributions (using non-Hispanic white infants from US studies 13 ) to derive the proportions of infants born at various gestational ages and the mortality rates according to gestational age. The very close agreement between these studies shown in Fig 1 gives us confidence in using our assumed proportions of infants born in each gestational age group.…”

Section: E836mentioning

confidence: 99%

Cardiovascular Malformations Among Preterm Infants

2005

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ABSTRACT. Objective. Preterm birth and cardiovascular malformations are the 2 most common causes of neonatal and infant death, but there are no published population-based reports on the relationship between them. We undertook this study to determine the prevalence and spectrum of cardiovascular malformations in a preterm population, the prevalence of prematurity among infants with cardiovascular malformations, and the influence of prematurity and cardiovascular malformations on outcomes.Methods. We based the study on the population of the former Northern Health Region of England. We identified all live-born infants with cardiovascular malformations diagnosed in the first 1 year of life from the regional pediatric cardiology database, which includes the gestational age and details of the diagnosis. We limited ascertainment to malformations diagnosed by the age of 12 months. Infants with isolated patent ductus arteriosus or atrial septal defect were excluded, to avoid ascertainment bias. Infants with ventricular septal defect were classified according to whether they required surgery in the first 1 year. There are no population data on gestational ages for all births in our population for the era of this study; therefore, we used data published in the literature for populations similar to our own to predict that 0.4% of live births occur at <28 weeks of gestation, 0.9% at 28 to 31 weeks, and 6% at 32 to 36 weeks. Overall, 7.3% of live-born infants are preterm.Results. Of 521 619 live-born infants in 1987-2001, 2964 had cardiovascular malformations (prevalence: 5.7 cases per 1000 live births). Cardiovascular malformations were present at 5.1 cases per 1000 term infants and 12.5 cases per 1000 preterm infants. The odds ratio (OR) for a cardiovascular malformation in prematurity was 2.4 (95% confidence interval [CI]: 2.2-2.7). We found that 474 infants (16%) with cardiovascular malformations were born at <37 weeks of gestation, giving an OR for prematurity among infants with a cardiovascular malformation of 2.4 (95% CI: 2.2-2.7). More infants were born preterm with diagnoses of pulmonary atresia with ventricular septal defect (23%), complete atrioventricular septal defect (22%), and coarctation of the aorta, tetralogy of Fallot, and pulmonary valve stenosis (each 20%). Fewer were born preterm with diagnoses of pulmonary atresia and intact ventricular septum (7%), transposition of the great arteries (8%), and single ventricle (9%). We found that 18% of infants with ventricular septal defect requiring surgery were preterm, compared with 13% in the nonsurgical group. Preterm infants with ventricular septal defect required surgery in 30% of cases, compared with 23% of term infants with ventricular septal defect. These figures show that the excess of cardiovascular malformations among preterm infants cannot be explained by greater ascertainment of minor ventricular septal defects. In our denominator population, 646 live-born infants were recognized as having trisomy 21, and gestational age data were available for 609. Of ...

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“…28 GA and BW are major determining factors for survival and morbidity, and there is a combined effect resulting from both variables. 3,11,12 However, GA has a greater influence on the prognosis of VLBW. 31 In addition, given that BW is unknown before delivery, it is important to provide information on the prognosis based on GA. Week-to-week survival by GA is very useful in perinatal care settings to decide on the chances of delivery in situations where there is risk for both the mother and the baby.…”

Section: Discussionmentioning

confidence: 99%

“…6,10 However, such survival has been accompanied by a high percentage of potentially serious long-term sequelae. In addition to the younger gestational age (GA) and lower birth weight (BW), 11,12 the presence of intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and necrotizing enterocolitis (NEC) [13][14][15][16][17][18] has been associated with a worse prognosis.…”

Section: Introductionmentioning

confidence: 99%

Survival and morbidity of very low birth weight infants in a South American Neonatal Network

2014

Arch Argent Pediat

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Objective. To analyze survival and relevant morbidity by gestational age (GA) in very low birth weight (VLBW) infants (<1500 g) and, based on these data, develop a fact sheet to provide information to perinatal healthcare providers and very low birth weight preterm infants´parents. Study Design. Data were prospectively collected in relation to newborn infants with a birth weight between 500 g and 1500 g admitted to 45 sites of the Neocosur Neonatal Network (Red Neonatal Neocosur) between January 2001 and December 2011. Results. Data on 8234 VLBW with a GA between 24 +0 and 31 +6 weeks were analyzed. Overall mortality was 26% (95% CI: 25.0-26.9), including 2.6% of deaths in the delivery room. Fact sheets for survival and morbidity for each week of gestation were developed based on collected data. Survival at discharge increased from 29% at 24 weeks of GA to 91% at 31 weeks of GA (p < 0.001). The incidence of relevant neonatal morbidity was inversely related to GA (p < 0.001). Overall, 30.8% had retinopathy of prematurity, 25% bronchopulmonary dysplasia, 10.9% necrotizing enterocolitis, 7.2% severe intraventricular hemorrhage, and 4.6% periventricular leukomalacia. Among survivors, 47.3% had none of these five conditions. Conclusions. A tool for use in a clinical setting was developed based on updated regional data for establishing week-to-week survival and morbidity of newborn infants born between 24 +0 and 31 +6 weeks of GA. This information could be used to make decisions related to perinatal care and for counseling parents.

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Prediction of survival for preterm births by weight and gestational age: retrospective population based study

Abstract: Objective To produce current data on survival of preterm infants. Design Retrospective population based study. Setting Trent health region.

Cited by 212 publications

References 15 publications

Limits of viability: definition of the gray zone

Limits of viability: definition of the gray zone

Cardiovascular Malformations Among Preterm Infants

Survival and morbidity of very low birth weight infants in a South American Neonatal Network

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