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
 · 
68 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background In Brazil, the prevalence of prematurity has increased in recent years and it is a major cause of death in the neonatal period. Therefore, this study aims at assessing perinatal factors associated with early neonatal deaths in very low birth weight preterm infants born in a region of Brazil with low Human Development Index.Methods Prospective cohort study of inborns with gestational age 230/7-316/7 weeks and birthweight 500-1499 g without malformations in 19 public reference hospitals of the state capitals of Brazil¿s Northeast Region. Perinatal variables associated with early neonatal death were determined by Cox regression analysis.ResultAmong 627 neonates, 179 (29%) died with 0¿6 days after birth. Early death was associated to: absence of antenatal steroids (HR 1.59; 95%CI 1.11-2.27), multiple gestation (1.95; 1.28-3.00), male sex (2.01; 1.40-2.86), 5th minute Apgar <7 (2.93; 2.03-4.21), birthweight <1000 g (2.58; 1.70-3.88), gestational age <28 weeks (2.07; 1.42-3.02), use of surfactant (1.65; 1.04-2.59), and non-use of a pain scale (1.89; 1.24-2.89).Conclusion Biological variables and factors related to the quality of perinatal care were associated with the high chance of early death of preterm infants born in reference hospitals of Northeast Brazil.
    BMC Pediatrics 12/2014; 14(1):312. DOI:10.1186/s12887-014-0312-5 · 1.92 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; DOI:10.1038/jp.2014.70 · 2.35 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 (eg, 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.
    Obstetrics and Gynecology 05/2014; 123(5):1083-1096. DOI:10.1097/AOG.0000000000000243 · 4.37 Impact Factor