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Infants with gestational age 28 weeks or less
1Department of Neonatology, Juliane Marie Center for Women, Children and Reproduction, The National University Hospital (Rigshospitalet), Copenhagen.
Insights
Neonatal survival and disabilities in extremely premature infants were evaluated. Over 70% survived to discharge, but many experienced long-term impairments, highlighting the need for improved care strategies.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Neurology
Background:
- Extremely low gestational age infants (ELGA) face significant risks of mortality and disability.
- Understanding the impact of perinatal events and neonatal treatments is crucial for improving outcomes.
Purpose of the Study:
- To evaluate neonatal survival and subsequent disabilities in infants born at extremely low gestational age (≤28 weeks).
- To identify perinatal factors and neonatal interventions associated with adverse outcomes in this vulnerable population.
Main Methods:
- Retrospective follow-up study of 197 infants with gestational age ≤28 weeks admitted between 1987-1990.
- Data collected from medical records, parental questionnaires, and health authority recordings.
- Outcomes assessed included mortality, healthy survival, and disabled survival at a mean corrected age of 48 months.
Main Results:
- Mortality rate was 29%, with higher mortality in infants born at 24-25 weeks (49%) compared to 26-28 weeks (24%).
- At follow-up, 54% had no impairments, 22% had minor impairments, and 23% had moderate to severe disabilities.
- Significant risk factors for adverse outcomes included low Apgar score, low birth weight (<1000g), male sex, and birth at a non-specialized hospital.
Conclusions:
- Infants born at extremely low gestational age have a substantial risk of mortality and long-term disability.
- Perinatal factors and neonatal complications like intracranial hemorrhage significantly influence survival and functional outcomes.
- The findings underscore the need for specialized care and targeted interventions for ELGA infants to improve neurodevelopmental outcomes.
Abstract:
The objective of the study was to evaluate neonatal survival and subsequent disabilities in infants with extremely low gestational age in relation to perinatal events and neonatal treatment. A retrospective follow-up study was performed based on medical records, questionnaires to parents and recordings of contact with health authorities. All infants with a gestational age 28 completed weeks or less, who were admitted to the Department of Neonatology, Rigshospitalet, within 24 hours of age during the period January 1, 1987 - December 31, 1990 were included. During this period the basic therapeutic approach was a combination of minimal handling and early nasal-continuous positive airway pressure (CPAP) ("minitouch"). Main outcome measures were: mortality, healthy survival and disabled survival. Variables related to outcome were: risk factors present at birth (gestational age, birth weight, gender, place of birth (Rigshospitalet/other hospital), mode of delivery, Apgar score at five minutes; interventions in the neonatal period (intermittent positive pressure ventilation and treatment of hypotension); complications in the neonatal period (intracranial haemorrhage grade II-IV, periventricular leucomalacia, pneumothorax, seizures and septicaemia). One hundred and ninety-seven infants without major malformations were included. The mortality rate was 29%. Among infants with gestational age 24-25 weeks 49% died versus 24% of infants born after 26-28 weeks (p = 0.004). Mean gestational age was 26.7 weeks (range 24-28) and mean birth weight 994 g (range 525-1630). Fifty-five infants (28%) were small-for-gestational age. One hundred and fifty-five infants (79%) were born in our hospital and 115 (58%) were delivered by caesarean section. A total of 140 infants (71%) survived until discharge and none died between discharge and follow-up. At follow-up at a mean uncorrected age of 48 months information was obtained about all infants, except two (1%) who had emigrated; 75 (54%) had no impairments, 31 (22%) had minor impairments, 17 (12%) were moderately disabled, and 15 (11%) were severely disabled. Of the 197 infants 121 (61%) were treated with intermittent positive pressure ventilation, 83 (42%) with dopamine for hypotension, and 92 (47%) received parenteral nutrition. In 64 infants (33%) the course was complicated with intracranial haemorrhage (ICH) grade II-IV, in 17 (9%) with seizures, in 23 (12%) with pneumothorax, in 21 (11%) with septicaemia, and in 10 (5%) with necrotizing enterocolitis. Sixty infants (31%) needed medical or surgical closure of a persistent ductus arteriosus. In 11 infants (6%) cystic periventricular leucomalacia occurred, 10 infants (5%) developed retinopathy of prematurity stage 3-4, and 35 infants (24%) received supplementary oxygen at 28 days of age. Risk factors present at birth for adverse outcome were: Apgar score <7 at five minutes, birth weight <1000 g, male sex and birth in another hospital than Rigshospitalet, For adverse outcome in surviving infants only, ICH grade II-IV was the only significant risk factor.