Beyond the borderline: Outcomes for inborn infants born at ≤500 grams

Authors

  • Amy Keir,

    Corresponding author
    1. Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, Australia
    • Correspondence: Dr Amy Keir, Division of Neonatology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8. Fax: +1 (416) 813 5245; email: amy.keir@sickkids.ca

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  • Andrew McPhee,

    1. Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, Australia
    2. Robinson Institute, University of Adelaide, Adelaide, Australia
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  • Dominic Wilkinson

    1. Department of Neonatal Medicine, Women's and Children's Hospital Network, Adelaide, Australia
    2. Robinson Institute, University of Adelaide, Adelaide, Australia
    3. Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom
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  • Conflict of interest: The authors have no conflicts of interest relevant to this article to declare.
  • Study undertaken within: Department of Neonatal Medicine, Level 1 Queen Victoria Building, Women's and Children's Hospital, North Adelaide SA 5006.

Abstract

Aim

To report survival, morbidity and neurodevelopmental outcome in a cohort of extremely low birthweight infants.

Methods

Retrospective cohort study of all inborn infants born alive with birthweights ≤500 g ≥22 weeks gestation at Women's and Children's Hospital, Adelaide, Australia, over a 6-year period (2005–2010). Outcome data including standardised medical and psychological assessments at 12 and 36 months corrected age were collated from follow-up.

Results

A total of 36 eligible infants were born over the study period (mean gestational age (GA) 24.4 (range 22.0–30.0) weeks; birthweight 443 (330–500) grams). Twenty-six of the 36 (72%) infants were small for gestational age (SGA).Ten of the 36 infants received compassionate care and died in the delivery or operating room. Twenty-six of the 36 infants were admitted to the neonatal intensive care unit (NICU), of whom 12 (46%) died during their admission. At age 12 months corrected, 2/14 (14%) of survivors had none/minimal, 4/14 (29%) had mild and 8/14 (57%) had moderate/severe neurodevelopmental disability. Overall, the survival rate was 39%, and survival without neurodevelopmental disability was 6%. Only 1/10 appropriate-for-gestational-age (AGA) infants survived to discharge (and had severe disability), whereas 13/26 (50%) of all SGA infants in the study survived to discharge. Of all infants admitted to the NICU, 11/26 (42%) survived without severe neurodevelopmental disability at latest follow-up.

Conclusions

There was a high risk of death or impairment in this cohort of infants. Survival was rare for AGA infants weighing ≤500 g at birth. Our study provides an evidence base to assist counselling and decision-making.

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