Predictors of mortality and major morbidities in extremely low birth weight neonates

Objectives

To determine predictors of mortality and morbidity in extremely low birth weight neonates (ELBW) from a developing country

Study design

Prospective observational study.

Setting

Level III neonatal unit in Northern India.

Subjects

Neonates <1000g born and admitted to intensive care during study period were enrolled. They were analyzed based on survival and development of major morbidity. Multivariable logistic regression model was used to determine independent risk factors.

Outcome

Mortality and major morbidity (one or more of the following: Bronchopulmonary dysplasia (BPD), Retinopathy of Prematurity (ROP) requiring laser, grade III or IV intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL) and necrotizing enterocolitis (NEC) stage III) during hospital stay.

Results

Of 255 ELBW neonates born, 149 received optimal care, of which 78 (52%) survived and 57 (39%) developed morbidities. Mean birth weight and gestational age were 29.1±2.6 weeks and 843±108g. Major causes of mortality were sepsis (46%), birth asphyxia (20%) and pulmonary hemorrhage (19%). Birth weight ≤800g [OR (95% CI)-3.51 (1.39–8.89), P=0.008], mechanical ventilation [4.10 (1.64–10.28), P=0.003] and hypotensive shock [10.75 (4.00–28.89), P<0.001] predicted mortality while birth weight ≤800g [3.75 (1.47–9.50), P=0.006], lack of antenatal steroids [2.62 (1.00–6.69), P=0.048), asphyxia [4.11 (1.45–11.69), P=0.008], ventilation [4.38 (1.29–14.79), P=0.017] and duration of oxygen therapy [0.004 (1.001–1.006), P=0.002] were the predictors of major morbidities.

Conclusions

Low birth weight, mechanical ventilation and hypotensive shock predicted mortality in ELBW neonates while low birth weight, lack of antenatal steroids, birth asphyxia, ventilation and duration of oxygen therapy were predictors for major morbidity.     

Survival and morbidity among two cohorts of extremely low birth weight neonates from a tertiary hospital in Northern India

This study was conducted to compare the survival and morbidity of extremely low birth weight neonates born during two different time periods (2009–10 and 2001–02) at a Level III referral neonatal unit in Northern India. All consecutive intramural extremely low birth weight neonates (<1000g), irrespective of gestation, and admitted to Intensive Care were enrolled. 149 and 123 neonates were enrolled during 2009-10 and 2001-02, respectively. The baseline characteristics were comparable except for mean birth weight, which was lower during 2009-10 (843±108g vs 885±126g, P=0.003). Surfactant therapy (54% vs 18%, P<0.001), non-invasive ventilation (28% vs 6%, P<0.001), high frequency ventilation (24% vs 4%, P=0.001), IVH (52% vs 25%, P<0.001) and PDA (34% vs 18%, P=0.004) were significantly more during 2009–10. Culture positive sepsis (33% vs 51%, P=0.003) and ROP rates (7% vs 23%, P=0.042) were significantly higher during 2001–02. Overall survival was similar; however, neonates between 28–30 weeks gestation had better survival (63%) during 2009–10 compared to 2001–02 (38%), P=0.009. Survival in neonates 28–30 weeks improved during this period while overall survival remained the same.     

T-tube ileostomy for intestinal perforation in extremely low birth weight neonates

To evaluate the results of use of T-tube ileostomy in selected cases of intestinal perforation in extremely low birth weight (ELBW) neonates. The records of 288 ELBW neonates treated at author’s institution, from 1998 to 2003 were retrospectively reviewed to identify neonates operated for intestinal perforation with T-tube placement. T-tube was inserted into the bowel through the site of perforation or proximally to the perforated gut via separate stab incision. T-tubes were used in five ELBW neonates (BW 600–900 g, gestational age 25–27 weeks) with intestinal perforation, in four of them at the time of primary surgery and in one neonate 8 days after primary anastomosis. All patients survived and there were no serious complications related to the T-tube insertion. Median duration of T-tube placement was 4 weeks (range 3–8 weeks), full enteral feeding after T-tube insertion was achieved in 4 weeks (range 1–6 weeks). All sites of T-tube insertion closed spontaneously. T-tube ileostomy is an effective and safe technique for treatment of selected cases of intestinal perforation in ELBW neonates. With respect to the hypoperistalsis of immature bowel, we recommend the use of T-tube in all cases of isolated intestinal perforation in ELWB neonates.     

Survival and morbidity in extremely low birth weight (ELBW) infants

We report the morbidity and mortality in extremely low birth weight neonates (ELBW) from a tertiary care hospital over seven years (1994-2000). Data regarding maternal and neonatal details was obtained from old records, computer database and medical files. Of the 12,807 live births during this period, 137 (1.07%) were ELBW infants. All of them were managed without surfactant. Overall, 67 infants (48.7%) survived to discharge. The most commonly encountered morbidities were hyperbilirubinemia(65%), respiratory distress(65%), sepsis(52%), intraventricular hemorrhage(29%), pneumonia (25%) and retinopathy of prematurity(24%). Need for resuscitation, pulmonary hemorrhage, seizures, acute renal failure, sclerema and air leak syndromes were significantly associated with mortality. Sepsis accounted for 41% of all deaths while immaturity was the second most important cause, accounting for 24% deaths. The average length of stay for survivors was 49 days (SD +/- 15.9 days)     

Early predictors of mortality in very low birth weight neonates.

OBJECTIVE: To evaluate early predictors of mortality in very low birth weight neonates. SETTING: Teaching hospital. DESIGN: Case control study. METHODS: Hospital born very low birth weight newborns (500-1500 g) enrolled for study and followed up till death or 28 days. Infants' birth data and data on physiologic alterations, investigation and interventions in the first 24 hours of life and CRIB score were analyzed for their ability to predict neonatal mortality. RESULTS: 115 subjects were enrolled into the study of which 47 died in the neonatal period. The factors significantly associated with early neonatal mortality included birth weight, gestation, low Apgar scores, need for assisted ventilation at birth, need for supplemental oxygen and mechanical ventilation in the first 24 hours, presence of shock, hypoxia and acidosis (p < 0.05). The factors associated with late neonatal mortality were birth weight and gestation only. Multivariate analysis of these factors showed that besides low birth weight, shock, need for mechanical ventilation, acidosis and high alveolar-arterial oxygen gradients were significant predictors of neonatal mortality. When compared with the CRIB score, birth weight <1200g proved to be an equally good predictor of mortality risk. CONCLUSION: VLBW neonates with disturbed cardio-pulmonary physiology during the first 24 hours of life, especially those in need of mechanical ventilation, are at an increased risk of early neonatal mortality.     

极低及超低出生体重儿的预后因素分析

目的 分析极低及超低出生体重儿（出生体重≤ 1 200 g）的临床资料,为其预后及临床干预提供预警指标。方法 回顾性分析108 例极低及超低出生体重儿的母孕期病史、新生儿出生时情况、诊治经过及预后,采用非条件logistic 回归分析筛选预后的影响因素。结果 108 例极低及超低出生体重儿,出生体重范围在结论 极低及超低出生体重儿的病死率较高,且随着日龄的增加,影响早产儿生存的预后因素不同,临床上应针对这些因素制定合理的管理方案,提高早产儿生存率。     

Physical growth,morbidity profile and mortality among healthy late preterm neonates

Objective

To compare the physical growth outcomes, morbidity profile and mortality at an age of 12 months among late preterm (34^0/7 to 36^6/7) neonates to term (37^0/7 to 41^6/7) neonates.

Study design

Prospective cohort study.

Setting

A tertiary care center of Northern India during 2014-2015.

Participants

200 apparently healthy late preterms and term infants, followed up to 12 months of age.

Main outcome measures

Physical growth parameters, morbidity profile and mortality.

Results

At mean age of 12 months, mean (SD) weight, length and head circumference of late preterms were 7.4 (0.8) kg, 69.2 (2.5) cm and 43.0 (1.1) cm, respectively; which were significantly lower than that of the full term infants [8.7 (1.6) kg, 72.2 (3.1) cm and 44.2 (1.1) cm] (P < 0.001). On univariate analysis, late preterm group was associated with higher odds (95% CI) of being underweight [5.6 (3.4, 5.5)], stunted [3.5 (2.1, 5.8)] and wasted [3.6 (1.9, 6.9)]. On multivariate analysis, only adjusted odds of late preterms becoming underweight by one year was significant [OR 4.1; 95% CI (1.6, 10.4)]. Feeding difficulties, jaundice and re-hospitalization rates were significantly higher in the late preterm group. The median (IQR) episodes per baby for late preterms as compared to terms for diarrhea [1.84 (0,3) vs 1.14 (0,2) (P <0.001)], and fever [1.33 (0,2) vs. 0.95 (0,2) (P = 0.01)] were higher.

Conclusion

Healthy late preterms are at significantly higher risk of being underweight in the first year of life, in addition to having significantly higher morbidity.

     

Teenagers born at extremely low birth weight

Adolescence constitutes a major transition for extremely low birth weight (ELBW) teenagers. Recent studies of ELBW teenagers born in the 1980s have provided information about the growth and developmental characteristics of these individuals in adolescence and in early adulthood. ELBW teenagers are shorter and lighter than their full-term peers, and have a smaller head circumference. Cognitive and academic vulnerabilities documented during the school years, particularly difficulties with nonverbal intelligence and arithmetic, persist into late adolescence. Many ELBW children struggle in school and have lower academic achievement levels. The self-concept of ELBW teenagers is generally similar to that of their full-term peers, but their parents perceive them to be more vulnerable over a wide range of behavioural and psychosocial dimensions, particularly depression and attention. ELBW teenagers perceive themselves as needing more assistance in job seeking than do their peers. Physical activity levels and fitness in late adolescence are significantly lower in ELBW teenagers than in their full-term peers, constituting a potential additional health hazard in later life. The outcomes of ELBW teenagers are significantly influenced by socioeconomic, family and parenting factors.     

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超低出生体重儿(extremely low birth weight infant,ELBWI)是指出生体重低于1000g的新生儿,大多为胎龄小于32周的极早产儿[1]。伴随围生期医学和新生儿医学的不断发展,ELBWI出生率不断上升,可能存活者的体重和孕周不断降低。