#Grand Rounds

Updated Outcomes Data for Neonates less than 500 Grams at Birth

BACKGROUND AND PURPOSE:

There is limited data on extremely low birthweight newborns
Bashir et al. (Am J Perinatol, 2017) describe survival, short-term, and long-term morbidities of neonates < 500g

Retrospective cohort study
Neonatal Follow-Up Program (NFUP) at British Columbia’s Women’s Hospital and Health Centre (BCWH)
- Prospectively enrolls neonates with birth weight ≤ 800 g
- Conducts multidisciplinary neurodevelopmental assessments at ages 4, 8, and 18 months corrected age (CA), and at 3 and 4.5 years chronological age since 1983
- The first survivor with birth weight < 500 g was born in 1985
Primary objectives
- Calculated survival and morbidity rates as well as neurodevelopmental impairment rates at 4.5 years of neonates < 500g
Secondary objective
- Compare outcomes of small for gestational age (SGA) infants against entire cohort where <500 g is appropriate for gestational age

Data from 549 neonates with birth weight < 500g was collected
Among liveborns
- 180 (83%) died in the delivery room
- 17 (8%) died in the NICU
- 21 (10%) survived
Among all births, 3.8% (21/549) survived
Of NICU survivors
- Median birth weight was 460 g
- Median gestational age was 25.9 weeks (range: 22.6-30.3 weeks)
- 71% were inborn | 50% male | 75% were SGA
20% were a twin or multiple
Complications – Leading Short Term Morbidities
- Branchopulmonary dysplasia (91%)
- Culture proven sepsis (50%)
- Retinopathy of prematurity (41%)
- Severe brain injury (22%)
Complications – Long Term Morbidities
- 27% had no long-term impairment
- 23% had one, 23% had two, 18% had three, and 9% had four impairments in motor, cognitive, vision, and/or hearing domains
At 4.5 years
- 29% had visual impairment
- 10% wore hearing aids
- 50% had an IQ <70
- 18% cerebral palsy
- 68% had low motor scores

Approximately 4% of births <500 g survived, with all survivors having short-term morbidities
27% of neonates survived without long-term impairment

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