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The extremely low birthweight infant: the twenty-first century dilemma
P Jakobi1, A Weissman, E Paldi
1Department of Obstetrics and Gynecology B, Rambam Medical Center, Technion-Faculty of Medicine, Haifa, Israel.
Insights
Intensive care for extremely low birthweight infants (ELBW) shows limited survival gains, especially for those under 600 gm. Survivors face high morbidity rates, questioning the overall benefit of aggressive interventions.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Intensive Care
Background:
- Survival rates for very low birthweight infants (<1500 gm) have significantly improved over 20 years.
- High-tech intensive care is now applied to borderline viable infants, including those previously considered nonviable.
- Focus is on extremely low birthweight (ELBW) infants (<750-800 gm), a subgroup with inconsistent data.
Purpose of the Study:
- To review recent literature on intensive care outcomes for ELBW infants (<750-800 gm).
- To analyze survival rates, mortality, and morbidity in this vulnerable population.
- To evaluate the effectiveness of aggressive care approaches in borderline viability.
Main Methods:
- Literature review of recent studies on ELBW infant intensive care.
- Analysis of data on incidence, mortality, and morbidity.
- Examination of outcomes for infants weighing less than 750 gm or 800 gm.
Main Results:
- Improved survival (33-62%) noted for infants weighing 750-800 gm.
- Minimal overall survival improvement for infants below 600 gm.
- Alarmingly high morbidity (up to 70%) in survivors, particularly those <600 gm.
- For every healthy ELBW survivor, at least one has moderate to severe handicaps.
Conclusions:
- Aggressive high-tech care for borderline viability infants does not necessarily improve outcomes compared to less aggressive approaches.
- High morbidity rates in ELBW survivors raise concerns about the net benefit of intensive care.
- Active involvement of families and society in decision-making is crucial due to the profound consequences.
Abstract:
The survival rate of very low birthweight infants (weighing less than 1500 gm) has dramatically increased over the past two decades. Consequently, high-tech intensive care is offered to an increasing number of infants with borderline viability, previously considered as miscarriages. We reviewed the most recent literature on the results of intensive care used in the subgroup of extremely low birthweight infants, weighting less than 750 gm or 800 gm. Since definitions, management policies, and follow-up reports in this group of newborns are not consistent, the important statistical variables of incidence, mortality, and morbidity are incomplete and severely biased. In the past decade there was a growing tendency toward using a more active approach in caring for these infants. Most of the success is among the infants weighing 750 to 800 gm, with a survival rate in the range of 33 to 62%. However, the overall improvement in survival is small, with an extremely poor outlook for infants below 600 gm. The morbidity rate in the survivors is alarmingly high, reaching 70% and most common in infants with birthweight less than 600 gm. The available data show that virtually for every "healthy" surviving extremely low birthweight infant there is also at least one surviving child who is moderately to severely handicapped. The overall consequences and implications of high-tech care of these borderline viability infants, once considered as nonviable, are not necessarily improved over those of the former, less aggressive, approach. Since these results have grave consequences for the involved families and society, we urgently need to involve these parties more actively in decision making.