Neonatal outcomes of very preterm infants admitted to a tertiary center in Lithuania between the years 2003 and 2005

Abstract

The objectives of the study are to investigate gestational age-specific mortality and neonatal outcomes in preterm infants admitted to a tertiary center in Lithuania, and to make comparison with tertiary centers in western countries. Three hundred thirty-eight newborns born at ≤ 32 weeks of gestation and with birth weight ≤ 1,500 g between 1 January 2003 and 31 December 2005, admitted to the neonatal intensive care unit at Kaunas Medical University Hospital, were prospectively investigated. Mortality and associations between maternal, perinatal, and neonatal variables and short-term outcomes were examined for two gestational age (GA) groups (group I, extremely preterm, 22-27 weeks GA; group II, very preterm, 28-32 weeks GA). Mortality in group I was 53.5% and 2.9% in group II. GA <28 weeks, Apgar score <5 at 5 min, and birth weight <1,000 g posed the highest risk for death. Overall, 78.2% of the surviving infants were discharged from hospital without adverse short-term outcomes. The incidence of bronchopulmonary dysplasia (BPD) was 6.3%, of retinopathy of prematurity (ROP) requiring treatment 4.2%, of intraventricular hemorrhage (IVH) III-IV 10.9%, and for cystic periventricular leukomalacia (cPVL) 8.0%. In conclusion, a decade after introduction of perinatal programs, mortality in the very preterm group is similar to those reported from cohorts in western countries. In the extremely preterm group, however, mortality is still higher. Neonatal outcomes such as ROP are now similar, and BPD is lower to those in other cohorts, whereas the incidence of brain lesions is still higher. We speculate that differences in outcomes between studies may be explained by differences in resources, definitions, and treatment routines.

Early Nutritional Interventions for Brain and Cognitive Development in Preterm Infants: A Review of the Literature

“…Compared to term born infants, preterm infants, especially those born with very low birth weight (VLBW, less than 1500 g) and extremely low birth weight (ELBW, less than 1000 g), have higher rates of brain damage and brain lesions [2], show decreased cortical gray matter volumes [2,3,4], alterations in subcortical structures, decreased microstructural connectivity [3,5,6], and different patterns of neuronal activation, for example regarding language processing much later in life [4]. However, such activation differences do not necessarily result in cognitive delays later in life, as the developing brain is still plastic and shows impressive compensatory abilities.…”

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“…The present study was done to see the short-term morbidity for all VLBW infants who were admitted for neonatal intensive care in a tertiary care hospital in 2012 and 2013 and compare the outcomes of neonates in <30 wks GA with ≥30 wks .In our study, the C/S rate was 80% and was observed to be used more frequently in infants with a GA ≥30 wks. Jakuskiene et al [4] showed that delivery via C/S increased the survival rate. The association of poor survival with vaginal delivery implies that C/S might be recommended for delivery of these infants [3].…”

“…Another possibility is low survival rate of extreme low birth weight babies in our study, which are more prone to develop BPD. Jakuskiene et al [4] found the incidence of ROP requiring laser/cryocoagulation to be 9% for infants with a GA between 22 and 27 weeks and 2% for infants with a GA between 28 and 32 weeks. In our study, ROP is detected in one baby (stage 1).…”

Educational paper

“…In contrast, the incidence of any ROP and severe ROP in a Lithuanian cohort of preterm neonates (n=238) with a birth weight below 1,500 g and a gestational age below 32 weeks was 27% and 4%, respectively. When restricted to survivors <1,000 g, this is 48% and 10%, respectively (additional data provided by the authors) [23]. In addition to differences between units, there are also shifts in patient characteristics, ROP incidence and associated risk factors within a given unit or region.…”