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[Clinical analysis of 165 extremely low birth weight infants]
Yan Zhuang1, Xirong Gao1, Xinhui Liu1
1Department of Neonatology, Hunan Children's Hospital, Changsha 410007, China.
Insights
Extremely low birth weight infants (ELBWI) face severe complications and a low survival rate, often impacted by economic factors. Improving prenatal care and timely transfer to specialized neonatal wards are crucial for better outcomes.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Critical Care
Background:
- Extremely low birth weight infants (ELBWI) represent a vulnerable population with significant healthcare challenges.
- Understanding the clinical features and prognostic factors is essential for optimizing care strategies.
Purpose of the Study:
- To analyze the clinical characteristics, complications, treatment, and outcomes of hospitalized ELBWI.
- To identify factors influencing survival rates and neurodevelopmental impairments in this cohort.
Main Methods:
- Retrospective analysis of 165 hospitalized ELBWI between August 2008 and November 2013.
- Data collected included general information, birth details, prenatal care, delivery room management, complications, treatments, outcomes, and follow-up.
- Statistical analysis was performed to identify significant differences in survival and treatment abandonment rates.
Main Results:
- The study included 165 ELBWI with a mean gestational age of 28.4 weeks and birth weight of 910.9 g.
- High rates of complications were observed, including neonatal respiratory distress syndrome (77.0%), bronchopulmonary dysplasia (70.1%), and patent ductus arteriosus (50.0%).
- The overall survival rate was 51.5%, with mortality primarily attributed to economic factors and concerns about prognosis; 27.9% of followed-up infants showed neurodevelopmental impairment.
Conclusions:
- ELBWI experience severe complications, requiring intensive, prolonged treatment and resulting in a low survival rate.
- Improving prenatal steroid use and ensuring early, rational transfer to specialized neonatal care are vital.
- Advanced, integrated treatment technologies are necessary to enhance the management and outcomes of ELBWI.
Objective:
To analyze the clinical features and prognosis of extremely low birth weight infants (ELBWI).
Method:
Data of totally 165 hospitalized ELBWI between August 1st, 2008 and November 30th, 2013 in Hunan Children's Hospital were analyzed. The information of general data and births, prenatal care, delivery room stabilization, transfer information, complications, treatment, outcome and follow up were summarized.
Result:
(1) One hundred and sixty-five ELBWI were involved, their mean gestational age was (28.4±2.4) weeks, mean birth weight(910.9±93.1) g. (2) Rate of delivery in tertiary hospital was 46.7% (77/165) and prenatal steroids exposure was found in 52.1% (86/165). None of the cases were treated with continuous positive airway pressure (CPAP) in delivery room. (3) Rate of infants who were transfered to the class III b neonatal ward within 12 hours after birth was 58.8% (97/165). (4) The main complications of them included neonatal respiratory distress syndrome(NRDS, 77.0%, 127/165), bronchopulmonary dysplasia (BPD, 70.1%, 75/107), patent ductus arteriosus (PDA, 50.0%, 40/80), preterm retinopathy (ROP, 43.0%, 46/107), sepsis 39.4% (65/165), intraventricular hemorrhage (IVH, 34.8%, 49/141), necrotizing enterocolitis (NEC, 8.0%, 7/88). (5) TREATMENT: 97.6% (161/165) received oxygen therapy and 66.1% (109/165) received mechanical ventilation, 55.2% (91/165) used CPAP. 89.8% (114/127) of the NRDS used PS; 44.0% (33/75) of the BPD used low dose dexamethasone, 32.0% (24/75) used low dose nitric oxide; 60.0% (24/40) of the PDA used medication. 32.6% (15/46) of the ROP received laser photocoagulation. The average time of beginning enteral feeding was 2.0 d, the mean time to achieve full gastrointestinal feeding was 43.4 d. (6) OUTCOME: rate of survival in 165 cases with ELBWI was 51.5% (85/165), treatment was abandoned in 37.6% (62/165), total mortality was 48.5% (80/165). There were significant difference in survival rate between different birth weight group, gestational age group and admission age group (χ2=11.498, 8.789, 13.157, all P<0.05); There was significant difference in rate of giving up treatment between different birth weight and admission age groups (χ2=10.448, 8.259, all P<0.05). The primary cause of death was economic factor and worrying about prognosis. (7) Follow up: rate of neurodevelopmental impairment (NDI) in part of follow up cases was 27.9% (12/43).
Conclusion:
ELBWI have many severe complications and sequelae, which need complex treatment and long hospital stay with a low survival rate. In order to improve the level of treatment, we need to improve the rate of prenatal steroids, carry out intrauterine and postnatal, transport of ELBWI to III b neonatal ward as early and rationally as possible, give professional, sophisticated and integrated treatment technologies as far as possible.
