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Grand Rounds

Updated Outcomes Data for Neonates less than 500 Grams at Birth

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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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

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

Learn More – Primary Sources:

Survival, Short-Term, and Long-Term Morbidities of Neonates with Birth Weight < 500 g

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Related ObG Topics:

Can Abdominal Circumference Alone Be Used to Predict SGA or LGA Newborns?
Can Artery Doppler Studies Predict Small for Gestational Age Neonates?
Do Antenatal Corticosteroids Reduce Morbidity in Premature Neonates Prior to 24 weeks?

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