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Survival rate and 2 year outcome in very low birthweight infants
1Neonatal Intensive Care Unit, Sapir Medical Center, Kfar Saba, Israel.
Insights
This study tracked mortality and neurodevelopment in infants under 1,500g birthweight. Surfactant therapy improved survival, but severe brain conditions like IVH and PVL strongly predicted poor outcomes.
Area of Science:
- Neonatology
- Pediatric Neurology
- Medical Ultrasonography
Background:
- Infants with very low birthweight (<1,500g) face significant mortality and neurodevelopmental challenges.
- Intracranial pathologies diagnosed via ultrasonography are critical factors in infant outcomes.
Purpose of the Study:
- To determine the mortality rate for infants with birthweight <1,500g over a 5-year period.
- To evaluate 2-year neurodevelopmental outcomes and their correlation with intracranial pathologies.
- To assess the impact of exogenous surfactant therapy on survival rates.
Main Methods:
- Retrospective analysis of 282 infants with birthweight <1,500g (1987-1992).
- Neurodevelopmental assessment at 2 years for 114 surviving infants (born 1987-1990).
- Correlation of outcomes with intracranial pathologies identified by ultrasonography.
Main Results:
- Overall survival rate was 76.6%.
- Exogenous surfactant therapy (introduced 1991) significantly increased survival in 751-1,000g infants (P < 0.002).
- 19.3% of survivors had functional disabilities at 2 years; severe intraventricular hemorrhage (IVH) and cystic periventricular leukomalacia (PVL) were strongly associated with adverse outcomes (P < 0.001).
Conclusions:
- Efforts to save extremely premature infants (<1,000g BW) are crucial.
- Adverse neurodevelopmental outcomes are significantly linked to severe brain pathologies (IVH, PVL), not solely birthweight.
- Brain ultrasonography is a vital diagnostic tool for predicting infant outcomes and guiding clinical management.
Abstract:
The purpose of this study was to determine the mortality rate of 282 infants with a birthweight (BW) of < 1,500 g during a 5 year period (1987-92), and to evaluate 2 year neurodevelopmental outcome in 114 infants (born 1987-90) and its correlation with intracranial pathologies diagnosed by ultrasonography. Overall survival rate was 76.6% (216/282). With the introduction of exogenous surfactant therapy in 1991 a significant increase in survival was noted in the 751-1,000 g BW infants (from 20/36 to 20/22, P < 0.002). Two year evaluation was performed in 114 of 119 infants (95.7%) who survived this age. Twenty-two children (22/114, 19.3%) were functionally disabled, of whom 15 (13%) had a major disability. Of these 15 infants, 5/28 weighed < 1,000 g and 10/86 weighed 1,001-1,500 g (P = 0.6). Severe intraventricular hemorrhage (IVH) and cystic periventricular leukomalacia (PVL) were significantly associated with adverse outcome at 2 year (5/11 and 10/10 respectively were handicapped, P < 0.001). We therefore conclude that every effort should be made to save the extremely premature infants (< 1,000 g BW). Since adverse outcome was significantly associated with severe brain pathologies (large IVH and cystic PVL) rather than with lower BW, brain ultrasonography as a diagnostic mode should be taken into clinical consideration.