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[Survival, viability and prognosis of premature infant]
María Eugenia Hübner1, Rodrigo Ramírez
1Servicio de Neonatología, Hospital Clínico de la Universidad de Chile, Santiago de Chile. drhubner@lycos.com
Insights
Premature infants, especially those with very low birth weight, face significant mortality risks. Advances in neonatal care have improved survival rates, but outcomes vary by birth factors and can lead to disabilities.
Area of Science:
- Neonatology
- Perinatal Medicine
- Public Health
Background:
- Premature infants are a heterogeneous group with varying risks.
- Very low birth weight infants (<1500g) represent 0.9% of Chilean newborns but account for substantial neonatal (50-70%) and infant (25-30%) mortality.
- Improved perinatal care, neonatal intensive care units, mechanical ventilation, steroid use, and surfactant therapy have enhanced survival.
Purpose of the Study:
- To highlight the importance of defining premature infant subgroups.
- To discuss the challenges and ethical considerations in managing extremely premature infants.
- To underscore the variability in survival and associated disabilities.
Main Methods:
- Review of current understanding of premature infant classification and outcomes.
- Analysis of mortality data related to premature births in Chile.
- Discussion of advancements in neonatal intensive care.
Main Results:
- Survival rates for extremely premature infants have improved due to medical advancements.
- Survival is significantly influenced by place of birth, birth weight, and gestational age.
- Outcomes can include varying degrees of physical and mental disability.
Conclusions:
- Subgrouping premature infants is essential for accurate risk assessment and management.
- The limit of viability is a critical factor in ethical decision-making for imminent births.
- Continued advancements in neonatal care are crucial for improving outcomes and reducing long-term disabilities.
Abstract:
An heterogeneous group of newborns with different gestational ages, birth weight, nutritional status and different risks of morbidity and mortality are classified as premature. Therefore the definition of premature children subgroups is mandatory. Very low weight premature babies are those with a birth weight of less than 1500 g. In Chile, they correspond to 0.9% of newborns and they contribute to neonatal mortality with 50 to 70% and to infantile mortality, with 25 to 30%. Survival of extremely premature babies has improved significantly in the last decades, due to a better perinatal care, the appearance of neonatal intensive care units, the routine use of mechanical ventilation, the perinatal use of steroids and the introduction of exogenous surfactant. However, survival varies considerably according to the place of birth, birth weight and gestational age and may be associated with different degrees of physical and mental disability. The imminent birth of a child in the limit of viability will require complex and difficult ethical decisions. There is consensus that the limit of viability is 23 weeks and that it fluctuates between 24 and 26 weeks in different parts of the world.