General Obstetrics and Gynecology: Fetus-Placenta-Newborn
Survival, morbidity, and resource use of infants of 25 weeks’ gestational age or less,☆☆

Presented in part at the Annual Meeting of the American Pediatric Society/Society for Pediatric Research, San Francisco, Calif, May 1-4, 1999.
https://doi.org/10.1067/mob.2001.115280Get rights and content

Abstract

Objective: The objective of this study was to examine survival, morbidity, and resource use in a large cohort of extremely preterm infants. Study Design: We examined all (n = 754) neonatal intensive care unit admissions born at ≤25 weeks’ gestation and inborn deliveries (n = 949) between 22 and 25 weeks’ gestation at 17 Canadian neonatal intensive care units. Results: The overall survival rate was 63%, with a range from 14% at 22 weeks’ gestation to 76% at 25 weeks’ gestation. There was a high incidence of chronic lung disease (33%-51%), ≥grade 3 intraventricular hemorrhage (0%-16%), necrotizing enterocolitis (0%-14%), ≥stage 3 retinopathy of prematurity (27%-55%), nosocomial infection (25%-39%), and multiple gestation (18%-46%). Extremely preterm infants comprise 4% of neonatal intensive care unit admissions but account for 22% of deaths, 20%-60% of major morbidities, 11% of patient days, and 10%-35% of major procedures. Outborn infants had a higher incidence of chronic lung disease, severe retinopathy of prematurity, and intraventricular hemorrhage. Conclusion: Extremely preterm infants have a high incidence of mortality and morbidity and consume disproportionate amounts of neonatal intensive care unit resources. (Am J Obstet Gynecol 2001;185:220-6.)

Section snippets

Study population

We examined outcomes data for all (n = 754) live-born infants ≤25 weeks’ gestation who were admitted to 17 NICUs that participated in a national, multicentered, prospective study of Canadian NICUs from January 1996 to October 1997.9 All 17 hospitals except one were tertiary level regional referral centers and represented all geographic regions of Canada, which had a population of nearly 30 million people and more than 345,000 births in 1997.10 The 17 NICUs in the Canadian Neonatal Network

Infant characteristics

There were 754 live-born infants at ≤25 weeks’ GA who were admitted to a NICU (Table I).Of these infants, 551 were inborn and 203 were outborn (ie, delivered at a different hospital and transferred to an NICU). Another 398 inborn infants who were born between 22 and 25 weeks’ GA died in the delivery room. Among EPT infants admitted to a NICU, 2% had no previous prenatal care, but the percentage increased with decreasing GA. Maternal hypertension was present in 8%. The cesarean section rate

Comment

This study provides important recent data about outcomes of EPT infants born at ≤25 weeks’ GA. Previous authors have documented improvements in outcomes of EPT infants. Our results are consistent with these findings and suggest continuing improvements in outcomes when compared with previous reports from the National Institute of Child Health Network, the Vermont-Oxford Neonatal Network, and Johns Hopkins.1, 2, 3, 20 The improvement in survival is especially noticeable at the lower GAs. Forty

Acknowledgements

Members of the Canadian Neonatal Network: Shoo K. Lee, MBBS, FRCPC, PhD (Coordinator, Canadian Neonatal Network Coordinating Centre, Vancouver, British Columbia); Wayne Andrews, MD, FRCPC (Charles A. Janeway Child Health Centre, St John’s, Newfoundland); Ranjit Baboolal, MBChB, FRCPC (North York Hospital, N York, Ontario); Jill Boulton, MD, FRCPC (St Joseph’s Health Centre, London, Ontario; previously at Mt Sinai Hospital, Toronto, Ontario); David Brabyn, MBChB, FRACP, FRCPC (Royal Columbian

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    Supported by grant 40503 and grant 00152 from the Medical Research Council of Canada. Additional funding was provided by the B.C.’s Children’s Hospital Foundation; Calgary Regional Health Authority; Division of Neonatology, Children’s Hospital of Eastern Ontario; Child Health Program, Health Care Corporation of St John’s; The Neonatology Program, Hospital for Sick Children; Lawson Research Institute; Midland Walwyn Capital Inc; Division of Neonatology, McMaster Health Sciences Centre; Mount Sinai Hospital; North York General Hospital Foundation; Saint Joseph’s Health Centre; University of Western Ontario; Women’s College Hospital.

    ☆☆

    Reprint requests: Shoo K. Lee, MBBS, FRCPC, PhD, Coordinator, Canadian Neonatal Network, Canadian Neonatal Network Coordinating Centre, 4480 Oak St, Rm E-414, Vancouver, BC, Canada V6H 3V4.

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