Article

Day-by-Day Postnatal Survival in Very Low Birth Weight Infants

The George Washington University Medical Center, Newborn Services, Washington, DC 20037, USA.
PEDIATRICS (Impact Factor: 5.3). 08/2010; 126(2):e360-6. DOI: 10.1542/peds.2009-2810
Source: PubMed

ABSTRACT Postnatal survival rates of very low birth weight (VLBW) infants are well established for each birth weight or gestational age category. These figures do not differentiate viable infants who survive the first few days of life from extremely immature ones who die shortly after birth. This study aimed to develop standardized curves for day-by-day postnatal survival rates of VLBW infants.
National Inpatient Sample Database and its pediatrics-only subportion were analyzed for the years 1997-2004. Infants with birth weight <1500 g were included in the study. Infants were classified according to their birth weight into 4 groups: <500, 500 to 749, 750 to 999, and 1000 to 1499 g. Postnatal survival rates were calculated for each group at birth and at 1, 2, 3, 4 to 5, 6 to 7, 14, 21, 28, and >28 postnatal days.
Overall survival for infants with birth weight <500 g was 8%. Those who lived through the first 3 days of life had a chance of survival up to 50%. Infants in the 500- to 749-g group had overall survival rate of 50% that increased to 70% if they survived through the third day and 80% by the end of the first week. There was no improvement in the overall survival of any birth weight category over the years of the study.
VLBW infants who survive the first few postnatal days have a considerably better chance for life. We can predict postnatal survival chances for each birth weight category on a day-by-day basis until discharge.

0 Followers
 · 
73 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To characterise the actuarial day-by-day survival of premature infants in a geographically defined population. SETTING: 10 Neonatal Intensive Care Units (NICUs) in New South Wales (NSW) and Australian Capital Territory (ACT), Australia. DESIGN: Retrospective analysis of prospectively collected data as part of NICUs' data collection in NSW and ACT. SUBJECTS: Premature infants born at 22(+0) to 31(+6) weeks' gestation between January 1997 and December 2006 and admitted to one of the 10 NICUs in NSW and ACT. OUTCOME: Actuarial day-by-day survival to discharge from NICU. RESULTS: Survival to discharge after initiation of neonatal intensive care ranges from 30.0% at 23 weeks' gestation to 98.8% at 31 weeks. Actuarial day-by-day survival increased across all gestations. This improvement was most notable among the babies who were born <26 weeks gestation. CONCLUSION: Preterm infants who survive the first few postnatal days have considerable chances of long-term survival. It is important to revise the information stored regarding chances of survival so it covers chances at regular intervals, especially after the first few days of life.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 08/2011; 98(3). DOI:10.1136/adc.2011.210856 · 3.86 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this paper is to review observational studies that addressed the survival of pre-viable gestations in the United States. We searched PubMed, Ovid, CINAHL, and Web of Knowledge for studies reporting survival of infants born at <24 gestational weeks and/or <500g in the United States and published between January 2003 and January 2013. The full texts of 70 articles were examined and a total of 15 studies qualified and were selected. We analyzed fixed-effect and random-effects models for eight studies on survival to discharge. Pooled survival to discharge in the random-effects model was 45.9% (95% CI: 41.1-51.7) and 39.7% in the fixed-effect model (95% CI: 38.8-40.7). Studies differed by pre-viable survival measures and epochs (1985-2009). Protective factors included antenatal corticosteroids, neonatal resuscitation, and intensive care. The current survival threshold for pre-viable infants warrants reconsideration of the limits of viability. Protective factors that enhance survival should be considered in the management of these infants.
    Seminars in perinatology 12/2013; 37(6):389-400. DOI:10.1053/j.semperi.2013.06.021 · 2.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation), and the treatment options for the newborn. Upon review of the available literature, the workshop panel noted that the rates of neonatal survival and neurodevelopmental disabilities among the survivors vary greatly across the periviable gestations and are significantly influenced by the obstetric and neonatal management practices (for example, antenatal steroid, tocolytic agents and antibiotic administration; cesarean birth; and local protocols for perinatal care, neonatal resuscitation and intensive care support). These are, in turn, influenced by the variations in local and regional definitions of limits of viability. Because of the complexities in making difficult management decisions, obstetric and neonatal teams should confer prior to meeting with the family, when feasible. Family counseling should be coordinated with the goal of creating mutual trust, respect and understanding, and should incorporate evidence-based counseling methods. Since clinical circumstances can change rapidly with increasing gestational age, counseling should include discussion of the benefits and risks of various maternal and neonatal interventions at the time of counseling. There should be a plan for follow-up counseling as clinical circumstances evolve. The panel proposed a research agenda and recommended developing educational curricula on the care and counseling of families facing the birth of a periviable infant.Journal of Perinatology advance online publication, 10 April 2014; doi:10.1038/jp.2014.70.
    Journal of perinatology: official journal of the California Perinatal Association 04/2014; 35(2). DOI:10.1038/jp.2014.70 · 2.35 Impact Factor