Neonatal outcome of infants born at 500 to 800 grams from 1990 through 1998 in a tertiary care center.

OBJECTIVE

To assess if there have been changes in survival, demographic data, obstetric features, neonatal morbidity, and short-term neurologic/radiographic/neurosensory outcome of 500- to 800-g infants born in a tertiary care neonatal center from 1990 through 1998.

STUDY DESIGN

Records of all 500- to 800-g infants born at North Shore University Hospital during 1990-1998 were reviewed to determine demographic data, survival by weight and gestational age (GA), obstetric features, neonatal morbidity, and short-term neurologic/radiographic/neurosensory outcome. Newborn infants were grouped into three triennia: 1990-1992, 1993-1995, and 1996-1998 and compared across time.

RESULTS

Of the 173 infants admitted to the neonatal intensive care unit, 112 survived. Improved survival was documented: 40% in 1990-1992, 73% in 1993-1995, and 81% in 1996-1998 (p < 0.0001). Improved survival was also noted in each of the three weight cohorts, as well as in infants < or =26 weeks GA. An increased use of antenatal corticosteroids and increased number of deliveries by cesarean section (C/S) were noted across time. The incidence of 0 to 3 Apgar scores at both 1 and 5 minutes decreased across time. Necrotizing enterocolitis in survivors and expected short-term neurologic/radiographic/neurosensory outcome improved between 1990-1992 and 1996-1998, with a trend toward reduced IVH grade III to IV. The incidence of other neonatal morbidities did not change throughout the time period.

CONCLUSIONS

The data document that survival rates continued to improve for 500- to 800-g infants throughout the 1990s. This was concurrent with an increase in "low-risk, expected normal" infants, increased number of deliveries by C/S, decreased incidence of low Apgar scores at both 1 and 5 minutes, and an increased use of antenatal corticosteroids.