Advertisement

Neonatal survival and disability rate at age 18 months for infants born between 23 and 28 weeks of gestation

      Abstract

      OBJECTIVE: Our purpose was to determine gestational age - specific outcomes of infants born in a period of surfactant use. STUDY DESIGN: All 465 consecutive births between 23 and 28 weeks' gestation in a tertiary center from 1987 to 1992 were analyzed prospectively. At 18 months' corrected age, 217 of 254 (85%) survivors were evaluated. RESULTS: From 1987 and 1988 to 1991 and 1992 there was an increase in survival for infants born at 24 weeks (from 0% to 33%, p = 0.17), 25 to 26 weeks (38% to 71%, p < 0.005), and 27 to 28 weeks (66% to 84%, p < 0.05). At each weekly interval from 24 to 28 weeks of gestation the respective incidence of normality was 44%, 71%, 57%, 76%, and 72% (not significant) and the respective mean developmental quotient was 91 ± 17, 89 ± 25, 90 ± 24, 96 ± 15, and 96 ± 14 (not significant). CONCLUSIONS: Gestational age was strongly associated with outcome in terms of survival. Overall, 70% of children followed up were developing within the normal range. (AM J OBSTET GYNECOL 1996;174:833-8.)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Effer SB
        • Lopes LM
        • Whitfield MF
        When does outcome justify heroic interventions? Univariate analysis of gestational age - specific neonatal mortality and morbidity.
        J Soc Obstet Gynecol Can. 1992; 14: 39-49
        • Milligan JE
        • Shennan AT
        • Hoskins EM
        Perinatal intensive care: where and how to draw the line.
        AM J OBSTET GYNECOL. 1984; 148: 499-503
        • Doyle LW
        • Kitchen WH
        Do neurological impairments and disabilities increase with decreasing gestational age in survivors of borderline viability at birth?.
        Aust Paediatr J. 1987; 23: 211-212
        • vanZeben-van der Aa TM
        • Verloove-Vanhorick SP
        • Brand R
        • Ruys JH
        Morbidity of very low birthweight infants at corrected age of two years in a geographically defined population.
        Lancet. 1989; 1: 253-255
        • Wariyar U
        • Richmond S
        • Hey E
        Pregnancy outcome at 24-31 weeks' gestation: neonatal survivors.
        Arch Dis Child. 1989; 64: 678-686
        • Nwaesei CG
        • Young DC
        • Byrne JM
        • et al.
        Preterm birth at 23 to 26 weeks' gestation: is active obstetric management justified?.
        AM J OBSTET GYNECOL. 1987; 157: 890-897
        • Msall ME
        • Buck GM
        • Rogers BT
        • Merke D
        • Catanzaro NL
        • Zorn WA
        Risk factors for major neurodevelopmental impairments and need for special education resources in extremely premature infants.
        J Pediatr. 1991; 119: 606-614
        • Johnson A
        • Townshend P
        • Yudkin P
        • Bull D
        • Wilkinson AR
        Functional abilities at age 4 years of children born before 29 weeks of gestation.
        BMJ. 1993; 306: 1715-1718
        • Whyte HE
        • Fitzhardinge PM
        • Shennan AT
        • Lennox K
        • Smith L
        • Lacy J
        Extreme immaturity: outcome of 568 pregnancies of 23-26 weeks' gestation.
        Obstet Gynecol. 1993; 82: 1-7
        • Synnes AR
        • Ling EWY
        • Whitfield MF
        • 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; 125: 952-960
        • Ferrara TB
        • Hoekstra RE
        • Couser RJ
        • et al.
        Survival and follow-up of infants born at 23 to 26 weeks of gestational age: effects of surfactant therapy.
        J Pediatr. 1994; 124: 119-124
        • Long W
        • Thompson T
        • Sundell H
        • et al.
        Effects of two rescue doses of a synthetic surfactant on mortality rate and survival without bronchopulmonary dysplasia in 700- to 1350-gram infants with respiratory distress syndrome.
        J Pediatr. 1991; 118: 595-605
        • Hollingshead AB
        Two factor index of social position.
        : AB Hollingshead, New Haven, Connecticut1957
        • Griffiths R
        The abilities of young children. Child development research centre.
        : Young and Son, London1970
        • Glorieux J
        • Dussault JH
        • Letarte J
        • Guyda H
        • Morissette J
        Preliminary results on the mental development of hypothyroid infants detected by the Quebec Screening Program.
        J Pediatr. 1983; 102: 19-22
        • Amiel-Tison C
        • Stewart A
        Follow-up studies during the first five years of life: a pervasive assessment of neurological function.
        Arch Dis Child. 1989; 64: 496-502
        • Spinnato JA
        • Sibai BM
        • Shaver DC
        • Anderson GD
        Inaccuracy of Dubowitz gestational age in low birth weight infants.
        Obstet Gynecol. 1984; 63: 491-495
        • DiPietro JA
        • Allen MC
        Estimation of gestational age: implications for developmental research.
        Child Dev. 1991; 62: 1184-1199
        • Goldenberg RL
        • Nelson KG
        • Dyer RL
        • Wayne J
        The variability of viability: the effects of physicians' perceptions of viability on the survival of very low - birth weight infants.
        AM J OBSTET GYNECOL. 1982; 143: 678-684
        • Fenton AC
        • Field DJ
        • Mason E
        • Clarke M
        Attitudes to viability of preterm infants and their effect on figures for perinatal mortality.
        BMJ. 1990; 300: 434-436
        • Fetus and Newborn Committee, Canadian Paediatric Society; Maternal-Fetal Medicine Committee, Society of Obstetricians and Gynaecologists of Canada
        Management of the woman with threatened birth of an infant of extremely low gestational age.
        Can Med Assoc J. 1994; 151: 547-553
        • Allen MC
        • Donohue PK
        • Dusman AE
        The limit of viability - neonatal outcome of infants born at 22 to 25 weeks' gestation.
        N Engl J Med. 1993; 329: 1597-1601
        • Eg-Andersen G
        Prediction of outcome in 164 infants born after 24 to 28 weeks gestation.
        Acta Paediatr Scand Suppl. 1989; 360: 56-61
        • Msall ME
        • Rogers BT
        • Buck GM
        • Mallen S
        • Catanzaro NL
        • Duffy LC
        Functional status of extremely preterm infants at kindergarten entry.
        Dev Med Child Neurol. 1993; 35: 31220
        • Hack M
        • Taylor HG
        • Klein N
        • Eiben R
        • Schatschneider C
        • Mercuri-Minich N
        School-age outcomes in children with birth weights under 750 g.
        N Engl J Med. 1994; 331: 753-759
        • Robertson CMT
        • Hrynchyshyn GJ
        • Etches PC
        • Pain KS
        Population-based study of the incidence, complexity, and severity of neurologic disability among survivors weighing 500 through 1250 grams at birth: a comparison of two birth cohorts.
        Pediatrics. 1992; 90: 750-755