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The obstetric management in very-low-birth weight infants
1Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, R.O.C.
Insights
Very-low-birth weight infants face high risks of periventricular-intraventricular hemorrhage (PVH/IVH). Respiratory distress syndrome significantly increases PVH/IVH incidence in these vulnerable newborns.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Perinatal Medicine
Background:
- Very-low-birth weight (VLBW) infants (500-1,500 g) experience significant neonatal morbidity and mortality.
- Periventricular-intraventricular hemorrhage (PVH/IVH) is a major complication in VLBW infants.
Purpose of the Study:
- To investigate the incidence and risk factors of PVH/IVH in VLBW infants.
- To assess the impact of delivery methods and other factors on PVH/IVH and survival rates.
Main Methods:
- Retrospective study of 83 VLBW infants (500-1,500 g).
- Analysis of PVH/IVH incidence, timing, and mortality.
- Evaluation of factors including birth weight, respiratory distress syndrome (RDS), ventilation requirements, Apgar scores, delivery mode, and presentation.
Main Results:
- Overall neonatal morbidity was 86.7% and mortality 18.1%.
- PVH/IVH incidence was higher in infants <1,000 g (66.7%) with 50% mortality, versus 52.1% incidence and 12.7% mortality in infants 1,000-1,500 g.
- PVH/IVH predominantly occurred within 5 days of birth (93%).
- Respiratory distress syndrome (RDS) and ventilator use significantly increased PVH/IVH risk; low Apgar score (<3) at 5 minutes did not.
- Cesarean section and presentation type did not affect PVH/IVH incidence or survival.
Conclusions:
- VLBW infants, particularly those under 1,000 g, are at high risk for PVH/IVH with significant associated mortality.
- Early onset (within 5 days) is characteristic of PVH/IVH in this population.
- RDS and mechanical ventilation are critical risk factors for PVH/IVH, highlighting the need for respiratory support optimization.
Abstract:
Eighty-three very-low-birth weight (VLBW) infants weighing between 500 g and 1,500 g were studied. The neonatal morbidity and mortality were 86.7% and 18.1%, respectively. Sixty-six point seven percent (8/12) of the infants weighing under 1,000 g suffered from a periventricular-intraventricular or intracranial hemorrhage (PVH/IVH) and their mortality rate was 50%. The incidence of PVH/IVH was 52.1%, and the mortality rate was 12.7% when the birth weight was between 1,000 g and 1,500 g. Forty-nine percent of the PVH/IVH took place on the first day of neonatal life, and 93% developed within 5 days after delivery. Cesarean section neither reduced the incidence of PVH/IVH nor increased the survival rate whether in cephalic or breech presentation. The incidence of PVH/IVH was not affected by type of presentation or the interval between the rupture of membranes and the delivery. Respiratory distress syndrome (RDS) and the requiring of a ventilator for ventilation significantly increased the incidence of PVH/IVH, while a low Apgar score (less than 3) at 5 minutes did not.