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28-day survival rates of 6676 neonates with birth weights of 1250 grams or less
D L Phelps1, D R Brown, B Tung
1Department of Pediatrics, University of Rochester, NY.
Insights
Neonatal survival rates improve with higher birth weight and gestational age. Gestational age is the most critical factor, underscoring the need for accurate assessment in very low birth weight infants.
Area of Science:
- Neonatalogy
- Perinatal Epidemiology
- Pediatric Survival Analysis
Background:
- Premature birth and low birth weight are significant risk factors for neonatal mortality.
- Understanding survival predictors is crucial for improving outcomes in vulnerable infant populations.
Purpose of the Study:
- To analyze 28-day survival rates in very low birth weight neonates based on gestational age, birth weight, sex, and race.
- To identify the most significant predictors of neonatal survival.
Main Methods:
- Retrospective analysis of 6676 inborn neonates weighing less than 1251g, born between 1986-1987.
- Multivariate analysis to assess the significance of gestational age, birth weight, sex, race, single birth, and small-for-gestational-age status on survival.
Main Results:
- Overall 28-day survival increased significantly with both gestational age and birth weight.
- Gestational age and birth weight were the strongest predictors of survival.
- Apparent survival advantages for female and black neonates diminished when controlling for gestational age, indicating its primary influence.
Conclusions:
- Gestational age is the paramount determinant of survival in very low birth weight neonates.
- Accurate gestational age assessment is vital for very low birth weight infants.
- Further research into factors influencing survival in this population is warranted.
Abstract:
Survival rates specific for birth weight, gestational age, sex, and race are described for 6676 inborn neonates who weighed less than 1251 g at birth and were born during 1986 through 1987. Overall 28-day survival increased with gestational age and birth weight, from 36.5% at 24 weeks' gestation to 89.9% at 29 weeks' gestation, or from 30.0% for neonates of 500 through 599 g birth weight to 91.3% for neonates of 1200 through 1250 g. The expected birth weight-specific survival advantage for female neonates and black neonates diminished when the data were controlled for gestational age, showing that certain previously reported survival advantages are based on lower birth weight for a given gestational age. Multivariate analysis showed that all tested variables were significant predictors for survival, in order of descending significance: gestational age and birth weight, sex, race, single birth, and small-for-gestational-age status. The powerful effect of gestational age on survival highlights the need for an accurate neonatal tool to assess the gestational age of very low birth weight neonates after birth.