Very low birth weight infants--mortality and predictive risk factors

To determine the survival rates and risk factors associated with mortality in premature very low birth weight or VLBW (< or = 1500 grams) infants.

This is a part-retrospective and part-prospective study of VLBW infants admitted into the Special Care Nursery, University Hospital Kuala Lumpur, between August 1994 and July 1996.

Of the 184 infants without lethal congenital malformations, 144 (78%) infants survived till discharge. The causes of death included respiratory diseases (63%), infections (30%), gastrointestinal abnormalities (5%) and intracerebral haemorrhage (2%). On multivariate logistic regression analysis, birth weight of 1 kg or less [odds ratio (OR) 3.88, 95% Confidence Interval (CI) 2.22, 6.67, p < 0.001], gestational age of 28 weeks or less [OR 1.78, 95% CI 1.03, 3.03, p = 0.038], ventilatory support [OR 2.68, 95% CI 1.46, 4.92, p = 0.002] and male gender [OR 1.83, 95% CI 1.10, 3.06, p = 0.021] were significant predictive factors for increased mortality. In a subgroup of 87 infants who were ventilated for severe respiratory distress syndrome, their survival was predicted by birth weight above 1 kg, gestational age greater than 28 weeks, appropriate for gestational age and surfactant replacement therapy.

Mortality remains high for the very low birth weight and very premature infants. Prolonging the duration of pregnancy and administrating exogenous surfactant to ventilated infants with RDS are two important measures to improve survival amongst VLBW infants.