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Survival and morbidity of extremely premature infants based on obstetric assessment of gestational age
1Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill.
Insights
Early survival for extremely premature infants has significantly improved, with survival rates increasing from 20% at 24 weeks to 94% at 29 weeks gestation. Morbidity, including chronic lung disease and severe intraventricular hemorrhage, also decreased.
Area of Science:
- Neonatalogy
- Perinatology
- Obstetrics
Background:
- Extremely premature infants face significant risks of morbidity and mortality.
- Accurate gestational age assessment is crucial for perinatal management and clinical decision-making.
- Previous data on early outcomes for this population require updates.
Purpose of the Study:
- To present current early morbidity and mortality data for extremely premature infants.
- To correlate outcomes with obstetric assessment of gestational age.
- To inform obstetric decision-making and perinatal management.
Main Methods:
- Retrospective review of 141 live-born infants.
- Infants born between 24-29 weeks gestation with birth weights ≤1600g.
- Data collected from January 1986 to April 1988 at a level III neonatal intensive care unit.
Main Results:
- Neonatal survival to 30 days ranged from 20% at 24 weeks to 94% at 29 weeks gestation.
- Chronic lung disease at 30 days decreased from 100% at 24 weeks to 13% at 29 weeks.
- Severe intraventricular hemorrhage (grade 3-4) decreased from 100% at 24 weeks to 7% at 29 weeks.
Conclusions:
- Significant improvements in survival rates for extremely premature infants compared to pre-1986 data.
- Substantial decrease in early morbidity, including chronic lung disease and severe intraventricular hemorrhage.
- Gestational age-based data provide valuable clinical information for managing extremely premature births.
Abstract:
To provide current clinical information for obstetric decision-making and perinatal management, we present early morbidity and mortality data for extremely premature infants based on obstetric assessment of gestational age. We reviewed the records of 141 live-born infants with birth weights of 1600 g or lower born at a university hospital level III neonatal intensive care unit between January 1986 and April 1988, whose gestational ages estimated by antenatal obstetric evaluation were between 24-29 completed weeks. Neonatal survival to 30 days ranged from 20% at 24 weeks to 94% at 29 weeks. Chronic lung disease was present at 30 days in all infants born at 24 weeks' gestation, decreasing to 13% of infants born at 29 weeks' gestation. Rates of severe intraventricular hemorrhage (grade 3 or 4) ranged from 100% at 24 weeks to 7% at 29 weeks. These data represent a significant increase in survival and a decrease in early morbidity compared with those form similar populations before 1986.