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

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