Perinatal asphyxia and outcome of very low birthweight infants.

Seventy-eight very low birthweight (VLBW) infants (whose birthweights were 1500 g or less) were admitted to the Neonatal Special Care Unit in 1977. Seventy-two of them required treatment in the intensive care area; these represented 40% of admissions to that area of the Unit. The mortality rate was 20% for infants weighing 1001 g to 1500 g, and 52% for those weighing 501 g to 1000 g. An Apgar score of 0 to 3 at two minutes and five minutes was reported in 34% and 19% of VLBW infants respectively. Although there was no difference in birthweight between the groups with a high or low Apgar score, the mortality rate of infants with a five-minute Apgar score of 0 to 3 was 79% compared to 22% in those with a score of 4 to 10. Over 50% of the infants developed hyaline membrane disease regardless of Apgar score. However, in the infants with a five-minute Apgar score of 0 to 3, the severity of respiratory insufficiency was increased as indicated by increased requirement for high inspired oxygen, and the need for intermittent positive pressure ventilation. The duration of stay in the neonatal intensive care area, and the total length of hospital stay of the 49 VLBW survivors were shorter in the group with higher two-minute and five-minute Apgar scores. Long-term morbidity cannot yet be ascertained. It is likely that prevention, or prompt detection, and appropriate management of perinatal asphyxia would produce a further decline in mortality as well as morbidity for VLBW infants.