General Obstetrics and Gynecology: Fetus-Placenta-NewbornSurvival, morbidity, and resource use of infants of 25 weeks’ gestational age or less☆,☆☆
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
References (25)
- et al.
Perinatal outcomes of a large cohort of extremely low gestational age infants (twenty-three to twenty-eight completed weeks of gestation)
J Pediatr
(1994) - et al.
Survival and short-term outcome in newborns of 23 to 25 weeks’ gestation
Am J Obstet Gynecol
(1994) - et al.
SNAP-II: a simplified newborn illness severity and mortality risk score
J Pediatr
(2001) - et al.
Relationship of cerebral intraventricular hemorrhage and early childhood neurologic handicaps
J Pediatr
(1983) - et al.
Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Network, November 1989 to October 1990
Am J Obstet Gynecol
(1995) - et al.
Nitric oxide inhalation in infants with respiratory failure
J Pediatr
(1997) - et al.
Early postnatal dexamethasone therapy in preterm infants with severe respiratory distress syndrome: a double-blind controlled study
J Pediatr
(1990) - et al.
Outcomes of extremely-low-birth-weight infants between 1982 and 1988
N Engl J Med
(1989) - et al.
The limit of viability: neonatal outcome of infants born at 22 to 25 weeks’ gestation
N Engl J Med
(1993) - et al.
Viability, morbidity, and resource use among newborns of 501- to 800-g birth weight
JAMA
(1996)
The effects of corticosteroid administration before preterm delivery: an overview of the evidence from controlled trials
Br J Obstet Gynaecol
Reduced mortality in small premature infants treated at birth with a single dose of synthetic surfactant
J Pediatr Child Health
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Ethical aspects of care in extremely premature newborns: Limits of viability
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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.
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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.