Perinatal outcomes of a large cohort of extremely low gestational age infants (twenty-three to twenty-eight completed weeks of gestation)

Synnes, Anne; Ling, Emily; Whitfield, Michael F.; Mackinnon, Murray; Lopes, Laudelino Marques; Wong, Gloria Songmei; Effer, Sidney B.

doi:10.1016/s0022-3476(05)82015-3

Cited by 131 publications

(73 citation statements)

References 27 publications

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“…Previous studies have noted a wide range of survival rates for all births (including stillbirths) at this gestation, ranging from 0% to 37%. [5][6][7][9][10][11][12]14,[17][18][19]36,37 Some studies present survival rates for live births only, ranging from 0% to 53%. 5,7,10,11,14,[16][17][18]20,36,37,47 Other studies include only infants admitted to the NICU, with survival rates ranging from 0% to 66%.…”

Section: Discussionmentioning

confidence: 99%

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Maternal and Perinatal Outcomes of Pregnancies Delivered at 23 Weeks’ Gestation

Crane

Magee

Lee

et al. 2015

Journal of Obstetrics and Gynaecology Canada

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Objective: To evaluate the maternal and perinatal outcomes of pregnancies delivered at 23+0 to 23+6 weeks' gestation .Methods: This prospective cohort study included women in the Canadian Perinatal Network who were admitted to one of 16 Canadian tertiary perinatal units between August 1, 2005, and March 31, 2011, and who delivered at 23+0 to 23+6 weeks' gestation . Women were included in the network if they were admitted with spontaneous preterm labour with contractions, a short cervix without contractions, prolapsing membranes with membranes at or beyond the external os or a dilated cervix, preterm premature rupture of membranes, intrauterine growth restriction, gestational hypertension, or antepartum hemorrhage . Maternal outcomes included Caesarean section, placental abruption, and serious complication . Perinatal outcomes were mortality and serious morbidity .Results: A total of 248 women and 287 infants were included in the study . The rate of Caesarean section was 10 .5% (26/248) and 40 .3% of women (100/248) had a serious complication, the most common being chorioamnionitis (38 .6%), followed by blood transfusion (4 .5% (25/25) . Two subgroup analyses were performed: in one, antepartum stillbirths were excluded, and in the other only centres that indicated they offered fetal monitoring at 23 weeks' gestation were included and antepartum stillbirths were excluded . In each of these, perinatal outcomes similar to the overall group were found . Conclusion:Pregnant women delivering at 23 weeks' gestation are at risk of morbidity . Their infants have high rates of serious morbidity and mortality . Further research is needed to identify strategies and forms of management that not only increase perinatal survival but also reduce morbidities in these extremely low gestational age infants and reduce maternal morbidity .

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Section: Discussionmentioning

confidence: 99%

“…40,43,44,55 Some studies have reported data from over two decades ago, 6,40,42,55 and survival has improved during this time period. 5,56 Older data may therefore not reflect current rates of morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Maternal and Perinatal Outcomes of Pregnancies Delivered at 23 Weeks’ Gestation

Crane

Magee

Lee

et al. 2015

Journal of Obstetrics and Gynaecology Canada

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“…36 ELBW (Ͻ600 g) and gestational age (Ͻ25 GWs) were independent risk factors for death and also for short-term morbidity of surviving infants, a finding supported by other authors. 21,[37][38][39][40] By antenatal steroid treatment, the risk for death and IVH of the live-born infants could clearly be reduced. Even the survival rate of infants born at 22 to 24 GWs was higher in the group treated prenatally with steroids.…”

Section: Figmentioning

confidence: 99%

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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“…2 In addition, most previous reports were not population based, as they examined pooled data over several years of a small number of infants who were treated in different ways. [3][4][5][6][7] The aim of the present study was to examine GAspecific outcomes of a large population-based cohort of infants who were born at Յ26 weeks' gestation and cared for in all 19 perinatal centers of Belgium between January 1999 and December 2000 and to compare the results with those of other geographic GA-based cohorts available in the literature. [8][9][10][11][12][13][14][15] …”

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confidence: 99%

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

Vanhaesebrouck

Allegaert²,

Bottu³

et al. 2004

Pediatrics

182

123

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ABSTRACT. Objective. To determine mortality and morbidity at discharge from the hospital of a large population-based cohort of infants who were born at <26 weeks' gestation.Methods. Perinatal data were collected on extremely preterm infants who were alive at the onset of labor and born between January 1, 1999, and December 31, 2000, in all 19 Belgian perinatal centers.Results. A total of 525 infants were recorded. Lifesupporting care was provided to 322 liveborn infants, 303 of whom were admitted for intensive care. The overall survival rate of liveborn infants was 54%. Of the infants who were alive at the age of 7 days, 82% survived to discharge. Vaginal delivery, shorter gestation, air leak, longer ventilator dependence, and higher initial oxygen need all were independently associated with death; gender, plurality, and surfactant therapy were not. Among the 175 survivors, 63% had 1 or more of the 3 major adverse outcome variables at the time of discharge (serious neuromorbidity, chronic lung disease at 36 weeks' postmenstrual age, or treated retinopathy of prematurity). The chance of survival free from serious neonatal morbidity at the time of hospital discharge was <15% (21 of 158) for the admitted infants with a gestation <26 weeks.Conclusions. If for the time being prolongation of pregnancy is unsuccessful, then outcome perspectives should be discussed and treatment options including nonintervention explicitly be made available to parents of infants of <26 weeks' gestation within the limits of medical feasibility and appropriateness. Pediatrics 2004; 114:663-675; extreme prematurity, mortality, morbidity, population-based cohort.

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Perinatal outcomes of a large cohort of extremely low gestational age infants (twenty-three to twenty-eight completed weeks of gestation)

Cited by 131 publications

References 27 publications

Maternal and Perinatal Outcomes of Pregnancies Delivered at 23 Weeks’ Gestation

Maternal and Perinatal Outcomes of Pregnancies Delivered at 23 Weeks’ Gestation

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

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

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