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Is intensive care justified for infants weighing less than 801 gm at birth?
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Very low birth weight infants (<801 gm) had a 25% survival rate. Infants weighing 700-800 gm had a 35% survival rate, with 39% experiencing handicaps, suggesting focused NICU care for this group.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Intensive Care
Background:
- Extremely low birth weight (ELBW) infants (<801 gm) present significant survival and developmental challenges.
- Referral of ELBW infants from outlying hospitals often occurs when infants are in poor condition, impacting outcomes.
Purpose of the Study:
- To evaluate the survival rates and neurodevelopmental outcomes of ELBW infants admitted to a referral neonatal intensive care unit (NICU).
- To identify factors correlating with survival and intact outcomes in this vulnerable population.
Main Methods:
- Retrospective analysis of 158 infants with birth weights <801 gm admitted between 1974-1977.
- Follow-up of survivors to 18 months postterm to assess growth and neurodevelopmental status using standardized measures (e.g., Bayley Scales).
Main Results:
- Overall survival rate was 25%; 35% for infants weighing 700-800 gm. No intact survival was observed below 700 gm birth weight.
- Common causes of death included intracranial hemorrhage, respiratory distress syndrome (RDS), and infection.
- Among survivors, 49% had neurodevelopmental handicaps, with 39% in the 700-800 gm group. Common sequelae included growth failure and major neurologic deficits.
Conclusions:
- Birth weight ≥700 gm, gestation ≥26 weeks, absence of asphyxia, and good initial condition were significant factors for survival and intact outcomes.
- Intensive care may not be justified for infants <700 gm, but aggressive management for those 700-800 gm is warranted due to a lower handicap rate in survivors.
Abstract:
During 1974-1977, 158 infants of birth weights less than 801 gm were referred from outlying hospitals. The survival rate was 25% for the whole group and 35% for those weighing 700 to 800 gm. Many were in a poor condition on arrival. One hundred and nineteen died. The most common causes of death were intracranial hemorrhage (39), RDS (26), and infection (13). Thirty-seven of the 39 survivors were followed until 18 months postterm. Growth failure was common--57% were below the third percentile in weight, 37% in length, and 17% in head circumference. Three had retrolental fibroplasia. Five children (14%) had major neurologic sequelae. Eight were severely handicapped with a Bayley score of less than 70 and ten were moderately handicapped with a Bayley score between 70 and 84, resulting in a neurodevelopmental handicap rate of 49%. Significant factors correlating with survival and intact outcome were birth weight greater than or equal to 700 gm, gestation greater than or equal to 26 weeks, the absence of asphyxia, and good condition on arrival at the NICU. There was no intact survival below 700 gm birth weight. The handicap rate of survivors between 700 and 800 gm was only 39%. Although intensive care in a referral unit may not be justified for those less than 700 gm, every effort should be made in the care of those 700 to 800 gm.