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: 5.47).
08/2010; 126(2):e360-6. DOI: 10.1542/peds.2009-2810
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.
Available from: Mohamed E Abdel-Latif
[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 · 3.12 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Objective: Transport of infants born at the threshold of viability (<27 weeks) may negatively impact outcomes. Our neonatal intensive care unit (NICU) is an all-referral unit, and therefore all patients have been transported. This study examined survival rates and the factors that influenced survival in this specific population of extremely premature infants. Study design: The study setting was at an all-referral tertiary care NICU within a children's hospital. Data were collected from December 2004 to August 2008, and included 227 patients. Results: Overall, the survival-to-discharge rate for these infants was 78%. The primary causes of death were sepsis (41%), necrotizing enterocolitis (NEC) (27%), respiratory failure (18%), and severe intraventricular hemorrhage (IVH) (10%). By logistic discrete time hazard analyses, patients receiving dopamine (p < 0.01) or insulin (p < 0.01), with NEC (p < 0.05), or of gestational age 22, 23 or 24 weeks (p < 0.01) were more likely to die; while those born in the same county as the NICU (p < 0.01), receiving patent ductus arteriosis (PDA) treatment (p < 0.01) or peripheral intravenous central catheters (p < 0.01) were more likely to survive. Within the group of survivors the rate of cerebral palsy was 9% and the mean scores on the Bayley-III at 18 months corrected age were 95 ± 13, 90 ± 15, and 92 ± 14 in the cognitive, communication, and motor scales respectively. Conclusion: Infection, NEC, and respiratory failure were the primary causes of death among extremely premature infants in an all-referral NICU. New approaches to preventing infection, NEC, and bronchopulmonary dysplasia are needed for this population.
Journal of Neonatal-Perinatal Medicine 01/2012; 5(2). DOI:10.3233/NPM-2012-55511
[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 · 2.68 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.