Results of the intensive perinatal management of very-low-birth-weight infants (501 to 1,500 grams).

In January 1975 at the University of Colorado Medical Center, a program of intensive intrapartum and neonatal care went into effect for all infants with expected birth weights of over 600 gm. Data are presented on the 187 infants weighing 501 to 1,000 gm born in 1975 to 1976. The 70 infants weighing 501 to 1,000 gm had a perinatal mortality of 65% and a neonatal mortality of 55%. The perinatal mortality of the 117 infants weighing 1,001 to 1,500 gm was 25% and the neonatal mortality 20%. Among the 501- to 1,000-gm infants, cesarean section for delivery of abnormal presentations resulted in a lower perinatal mortality than did vaginal delivery. Apgar scores were predictive of an improved chance of survival, but scores of three or less even at five minutes were associated with a 25% survival rate. Of those infants who did not survive the neonatal period, over 70% had died by 48 hours of life. These results were achieved without the use of beta-mimetic tocolytic agents to inhibit labor or long-acting corticosteroids to enhance pulmonary maturation. The improved survival of the infants weighing 1,500 gm or less when compared with infants of similar weights in preceding years is attributed to more intensive perinatal management of these mothers and their very-low-birth-weight infants.