Has The Outcome for Extremely Low Gestational Age (ELGA) Infants Improved Following Recent Advances in Neonatal Intensive Care?

Battin, Malcolm; Ling, Emily; Whitfield, Michael F.; Mackinnon, Murray; Effer, Sidney B.

doi:10.1055/s-2007-994068

Cited by 57 publications

(55 citation statements)

References 9 publications

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“…The deteriorated outcome was primarily caused by visual impairments, whereas the incidence of cerebral palsy remained constant. In studies from the 1990s, neonatal survival rates of infants born at 22 to 23 GWs varied from 0% to 25% 21,23,28 and was 9% in our study, which was significantly lower than that of the infants born at 24 to 25 GWs (60%). However, statistically significant differences in neonatal survival among GW groups at 25 to 29 GWs were not found.…”

Section: Figcontrasting

confidence: 76%

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A National Short-Term Follow-Up Study of Extremely Low Birth Weight Infants Born in Finland in 1996–1997

Heinonen²,

et al. 2001

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ABSTRACT. Objectives. The aims of this prospective nationwide investigation were to establish the birth rate, mortality, and morbidity of extremely low birth weight (ELBW) infants in Finland in 1996 -1997, and to analyze risk factors associated with poor outcome.Participants and Methods. The study population included all stillborn and live-born ELBW infants (birth weight: <1000 g; gestational age: at least 22 gestational weeks [GWs]), born in Finland between January 1, 1996 and December 31, 1997. Surviving infants were followed until discharge or to the age corresponding with 40 GWs. National ELBW infant register data with 101 prenatal and postnatal variables were used to calculate the mortality and morbidity rates. A total of 32 variables were included in risk factor analysis. The risk factors for death and intraventricular hemorrhage (IVH) of the live-born infants as well as for retinopathy of prematurity (ROP) and oxygen dependency of the surviving infants were analyzed using logistic regression models.Results. A total of 529 ELBW infants (.4% of all newborn infants) were born during the 2-year study. The perinatal mortality of ELBW infants was 55% and accounted for 39% of all perinatal deaths. Of all ELBW infants, 34% were stillborn, 21% died on days 0 through 6, and 3% on days 7 though 28. Neonatal mortality was 38% and postneonatal mortality was 2%. Of the infants who were alive at the age of 4 days, 88% survived. In infants surviving >12 hours, the overall incidence of respiratory distress syndrome (RDS) was 76%; of blood culture-positive septicemia, 22%; of IVH grades II through IV, 20%; and of necrotizing enterocolitis (NEC) with bowel perforation, 9%. The rate of IVH grades II through IV and NEC with bowel perforation decreased with increasing gestational age, but the incidence of RDS did not differ significantly between GWs 24 to 29. A total of 5 infants (2%) needed a shunt operation because of posthemorrhagic ventricular dilatation. Two hundred eleven ELBW infants (40% of all and 60% of live-born infants) survived until discharge or to the age corresponding with 40 GWs. The oxygen dependency rate at the age corresponding to 36 GWs was 39%, and 9% had ROP stage III-V. Neurological status was considered completely normal in 74% of the surviving infants. The proportions of infants born at 22 to 23, 24 to 25, 26 to 27, and 28 to 29 GWs with at least one disability (ROP, oxygen dependency, or abnormal neurological status) at the age corresponding to 36 GWs were 100%, 62%, 51%, and 45%, respectively. Birth weight <600 g and gestational age <25 GWs were the independent risks for death and short-term disability. The primary risk factor for IVH grades II through IV was RDS. Low 5-minute Apgar scores predicted poor prognosis, ie, death or IVH, and antenatal steroid treatment to mothers with threatening premature labor seemed to protect infants against these. Some differences were found in the mortality rates between the 5 university hospital districts: neonatal mortality was significantly lower (25% vs 44%) in...

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Section: Figcontrasting

confidence: 76%

“…Besides of low survival rate, the infants born at 22 to 23 GWs also have poor outcome: long-term disability rates varied in previously mentioned studies from 67% to 100%. 21,23,28 In our study, no infant born at 22 to 23 GWs had completely normal short-term follow-up results.…”

Section: Figmentioning

confidence: 44%

A National Short-Term Follow-Up Study of Extremely Low Birth Weight Infants Born in Finland in 1996–1997

Heinonen²,

et al. 2001

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“…Thus there is still a need for more research on how to improve neonatal care. The outcome of this type of research will be beneficial for all premature infants whether they are boys or girls [102].…”

Section: Discussionmentioning

confidence: 99%

Sex and gender differences in newborn infants: why are boys at increased risk?

Elsmén

Steen

Hellström‐Westas

2004

The Journal of Men's Health & Gender

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Newborn boys have higher morbidity and mortality than girls. Several studies have shown that male newborn sex is an independent risk factor for adverse outcome. The specific mechanisms leading to the increased risks for newborn boys are not known. However, several sex-specific reactions and physiologic responses have been described in both the fetus and newborn infants. Some of these differences persist during childhood; although later other sex and gender-specific differences become more important. Recently, the research aiming at explaining the vulnerability in male infants has been intensified. Experimental data from newborn animals have shown that many sex differences can be explained by differences in hormonal function and stress responses. However, if these findings apply to humans as well is not yet known. The aim of this paper is to review literature on very early sex-specific differences and shed some light on the increased risks for male fetuses and newborn boys. ß 2004 WPMH GmbH. Published by Elsevier Ireland Ltd.

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“…Data regarding survival odds were obtained from the Vermont Oxford Network Quality Management Report for the most recent available year (2000). 5 Rates of major disability (Table 1) were derived from a comprehensive review of the published literature [6][7][8][9][10][11][12][13][14][15][16][17][18] that included cohorts from single referral centers 8,11,12,14,16 and from geographically defined regions. 6,7,9,10,13,15,17,18 We included only long-term outcome studies that reported data based on gestational age (information that is more useful in the context of prenatal counseling); reported follow-up data Ն18 months after the estimated date of delivery, with significant proportions of survivors assessed (11 studies had rates of 83-100% and 2 studies had rates of 54% and 73%); used validated tools for assessment; and had similar definitions for major disabilities, including mental retardation/neurodevelopmental delay, cerebral palsy, blindness, and deafness ( Table 1).…”

Section: Interventionmentioning

confidence: 99%

“…24,25 Outcome statistics are generally well received by prospective mothers of preterm infants during prenatal consultation. 3 According to published data, the chances of survival increase by 2% to 4% with each additional intrauterine day for gestations of 23 to 26 weeks, 5,15,26 and the majority of infants who survive are free of major disabilities. 27 There seems to be sufficient evidence now to establish the limit of viability in the United States at 23 weeks of gestation.…”

Section: E484mentioning

confidence: 99%

Ensuring Accurate Knowledge of Prematurity Outcomes for Prenatal Counseling

et al. 2005

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ABSTRACT. Objectives. To determine the accuracy of knowledge of different health care providers regarding survival and long-term morbidity rates for very premature infants and to examine whether a focused educational intervention improves the accuracy of this knowledge and influences health care decisions.Methods. Using hypothetical case scenarios with infants at <28 weeks of gestation, we surveyed a variety of caregivers involved in perinatal communication and decision-making processes at a tertiary center that provides intensive care for neonates. We asked physicians from the pediatrics and obstetrics services and nurses and nurse practitioners from the NICU and obstetrics ward for their best estimates of survival and major long-term disability rates and for their opinions regarding the appropriateness of resuscitation and life support at each week of gestation of <29 weeks. After the survey, we educated all providers about current data on survival and long-term disability rates for preterm infants and gave them pocket-sized cards summarizing this information for reference during prenatal counseling. One month after the educational intervention and complete dissemination of the cards, a questionnaire with questions identical to those in the first survey was mailed to the same individuals.Results. Fifty-one health care providers were involved in the baseline survey. The response rates for the postintervention survey were 100% for physicians (20 of 20 subjects) and nurses (20 of 20 subjects) and 91% (10 of 11 subjects) for the nurse practitioners. In the baseline survey, statistically significant underestimates of survival rates were seen for physicians and nurses at 23 to 28 weeks of gestation and for nurse practitioners at 23 to 27 weeks of gestation. Statistically significant overestimates of disability rates were seen for physicians and nurse practitioners at <26 weeks of gestation and for nurses at <28 weeks of gestation. After the intervention, respondents demonstrated significant improvements in the accuracy of survival and disability estimates at many, but not all, gestational ages. Although underestimation of survival rates and overestimation of disability rates decreased after the intervention, it persisted to some degree. After the intervention, a larger proportion of physicians (53% vs 21%) and a smaller proportion of nurses (10% vs 37%) were likely to recommend resuscitation for infants born at 23 weeks of gestation.Conclusions. Physicians, nurses, and nurse practitioners underestimated survival rates and overestimated long-term disability rates for very premature infants. After education, their estimates of survival and long-term disability rates for these infants improved significantly. More accurate estimates of survival and disability rates affected physicians' and nurses' theoretical decisionmaking regarding the appropriateness of resuscitation at 23 weeks of gestation. Pediatrics 2005;115:e478-e487. URL: www.pediatrics.org/cgi

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Has The Outcome for Extremely Low Gestational Age (ELGA) Infants Improved Following Recent Advances in Neonatal Intensive Care?

Cited by 57 publications

References 9 publications

A National Short-Term Follow-Up Study of Extremely Low Birth Weight Infants Born in Finland in 1996–1997

A National Short-Term Follow-Up Study of Extremely Low Birth Weight Infants Born in Finland in 1996–1997

Sex and gender differences in newborn infants: why are boys at increased risk?

Ensuring Accurate Knowledge of Prematurity Outcomes for Prenatal Counseling

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