Am J Perinatol 2017; 34(13): 1333-1339
DOI: 10.1055/s-0037-1603462
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Rani A. Bashir
1   Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
,
Julianne Petrie Thomas
2   Neonatal Program, British Columbia's Women's Hospital, Vancouver, British Columbia, Canada
,
Margot MacKay
2   Neonatal Program, British Columbia's Women's Hospital, Vancouver, British Columbia, Canada
,
Jennifer Agnew
2   Neonatal Program, British Columbia's Women's Hospital, Vancouver, British Columbia, Canada
,
Philippa Hubber-Richard
2   Neonatal Program, British Columbia's Women's Hospital, Vancouver, British Columbia, Canada
,
Ruth E. Grunau
1   Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
2   Neonatal Program, British Columbia's Women's Hospital, Vancouver, British Columbia, Canada
3   BC Children's Hospital Research Institute, Vancouver, Canada
,
Anne Synnes
1   Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
2   Neonatal Program, British Columbia's Women's Hospital, Vancouver, British Columbia, Canada
3   BC Children's Hospital Research Institute, Vancouver, Canada
› Author Affiliations
Further Information

Publication History

15 January 2017

20 April 2017

Publication Date:
22 May 2017 (online)

Abstract

Objectives The objective of this study was to describe survival, short-term, and long-term morbidities of neonates with birth weight < 500 g.

Study Design Retrospective cohort studies to calculate survival, short-term, and long-term morbidity rates of neonates born weighing < 500 g from 1993 to 2012 and neurodevelopmental impairment rates at 4.5 years for births 1993 to 2008 in one center.

Results Of 549 inborn neonates with birth weight < 500 g, 4% survived. For live births and neonatal intensive care unit (NICU) admissions, 10 and 55% survived, respectively. Of 28 NICU (inborn and outborn) survivors (median birth weight 460 g and gestation 25.9 weeks [range: 22.6–30.3 weeks]), 71% were inborn, 50% male, and 75% were small for gestational age. One in five neonates was a twin or multiple. Short-term morbidities noted were bronchopulmonary dysplasia (91%), culture proven sepsis (50%), retinopathy of prematurity (41%), and severe brain injury (22%); 27% had no long-term impairment, 23% one, 23% two, 18% three, and 9% four impairments in motor, cognitive, vision, and/or hearing domains. At 4.5 years, 29% had visual impairment, 10% wore hearing aids, 50% had IQ < 70, 18% cerebral palsy, and 68% had low motor scores.

Conclusion Only 4% of births < 500 g survived. All survivors had short-term morbidities; 27% neonates survived without long-term major impairments.

Authors' Contributions

R.A.B. conceptualized the study, coordinated and supervised the data extraction, drafted the initial article, and approved the final article as submitted. J.P.T. performed the data analysis and interpretation, reviewed and revised the article, and approved the final article as submitted. M.M., J.A., and P.H. helped in interpreting the data, reviewed the article, and approved the final article as submitted. R.E.G. critically reviewed the data interpretation, revised the article, and approved the final article as submitted. A.S. designed the study, supervised the study, critically reviewed and revised the article, and approved the final article as submitted.


 
  • References

  • 1 Younge N, Goldstein RF, Bann CM. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Survival and neurodevelopmental outcomes among periviable infants. N Engl J Med 2017; 376 (07) 617-628
  • 2 Jefferies AL, Kirpalani HM. ; Canadian Paediatric Society Fetus and Newborn Committee. Counselling and management for anticipated extremely preterm birth. Paediatr Child Health 2012; 17 (08) 443-446
  • 3 Lucey JF, Rowan CA, Shiono P. , et al. Fetal infants: the fate of 4172 infants with birth weights of 401 to 500 grams--the Vermont Oxford Network experience (1996-2000). Pediatrics 2004; 113 (06) 1559-1566
  • 4 Sattler JM, Dumont R. Assessment of Children: WISC-IV and WPPSI-III Supplement. San Diego: Jerome M. Sattler Publisher; 2004
  • 5 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
  • 6 Kramer MS, Platt RW, Wen SW. , et al; Fetal/Infant Health Study Group of the Canadian Perinatal Surveillance System. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 2001; 108 (02) E35 . Doi: 10.1542/peds.108.2.e35
  • 7 Synnes AR, Anson S, Arkesteijn A. , et al. School entry age outcomes for infants with birth weight ≤ 800 grams. J Pediatr 2010; 157 (06) 989-994.e1
  • 8 Synnes AR, Buchanan L, Ruth C. , et al. Management of the newborn delivered at the threshold of viability. B C Med J 2008; 50: 444-454
  • 9 Hack M, Fanaroff AA. Outcomes of children of extremely low birthweight and gestational age in the 1990s. Semin Neonatol 2000; 5 (02) 89-106
  • 10 Rieger-Fackeldey E, Schulze A, Pohlandt F, Schwarze R, Dinger J, Lindner W. Short-term outcome in infants with a birthweight less than 501 grams. Acta Paediatr 2005; 94 (02) 211-216
  • 11 Rysavy MA, Li L, Bell EF. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med 2015; 372 (19) 1801-1811
  • 12 Keir A, McPhee A, Wilkinson D. Beyond the borderline: outcomes for inborn infants born at ≤500 grams. J Paediatr Child Health 2014; 50 (02) 146-152
  • 13 Nishida H. Improved outcome of infants born at less than 24 weeks of gestation in Japan. J Health Med Informat 2013; S11: 001 . Doi: 10.4172/2157-7420.S11-001
  • 14 Qiu X, Lodha A, Shah PS. , et al; Canadian Neonatal Network. Neonatal outcomes of small for gestational age preterm infants in Canada. Am J Perinatol 2012; 29 (02) 87-94
  • 15 Stoll BJ, Hansen NI, Bell EF. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (03) 443-456
  • 16 Sauve RS, Robertson C, Etches P, Byrne PJ, Dayer-Zamora V. Before viability: a geographically based outcome study of infants weighing 500 grams or less at birth. Pediatrics 1998; 101 (3 Pt 1, suppl): 438-445
  • 17 Mercier CE, Dunn MS, Ferrelli KR, Howard DB, Soll RF. ; Vermont Oxford Network ELBW Infant Follow-Up Study Group. Neurodevelopmental outcome of extremely low birth weight infants from the Vermont Oxford Network: 1998-2003. Neonatology 2010; 97 (04) 329-338
  • 18 Vohr BR, Wright LL, Dusick AM. , et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. Pediatrics 2000; 105 (06) 1216-1226
  • 19 Rieger-Fackeldey E, Blank C, Dinger J, Steinmacher J, Bode H, Schulze A. Growth, neurological and cognitive development in infants with a birthweight <501 g at age 5 years. Acta Paediatr 2010; 99 (09) 1350-1355
  • 20 Vital Statistics Agency- Province of British Columbia. Statistics and Reports. Available at: http://www2.gov.bc.ca/gov/content/life-events/statistics-reports/annual-reports . Accessed June 13, 2016
  • 21 Stoll BJ, Hansen NI, Bell EF. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in care practices, morbidity, and mortality, of extremely preterm neonates, 1993–2012. JAMA 2015; 314 (10) 1039-1051
  • 22 Soll RF, Edwards EM, Badger GJ. , et al. Obstetric and neonatal care practices for infants 501 to 1500 g from 2000 to 2009. Pediatrics 2013; 132 (02) 222-228
  • 23 Kramer MS. Gestational age, birthweight, and their influence on neonatal outcome. Acta Paediatr 2015; 104 (01) 5-6
  • 24 Serenius F, Blennow M, Maršál K, Sjörs G, Källen K. ; EXPRESS Study Group. Intensity of perinatal care for extremely preterm infants: outcomes at 2.5 years. Pediatrics 2015; 135 (05) e1163-e1172