Short-term outcome after active perinatal management at 23-25 weeks of gestation. A study from two Swedish perinatal centres. Part 3: neonatal morbidity.

Abstract

AIM:

To determine major neonatal morbidity in surviving infants born at 23-25 weeks, and to identify maternal and infant factors associated with major morbidity.

METHODS:

The medical records of 224 infants who were delivered at two tertiary care centres in 1992-1998 were reviewed retrospectively. At these centres, policies of active perinatal and neonatal management were universally applied. Of the 213 liveborn infants, 140 (66%) survived to discharge. Data were analysed by gestational age and considered in three time periods. Logistic regression models were used to identify factors associated with morbidity.

RESULTS:

Of the survivors, 6% had intraventricular haemorrhage grade > or = 3 (severe IVH) or periventricular leukomalacia (PVL), 15% retinopathy of prematurity > or = stage 3 (severe ROP) and 36% bronchopulmonary dysplasia (BPD). On logistic regression analysis, severe IVH or PVL was associated with duration of mechanical ventilation (odds ratio, OR: 1.53 per 1-wk increment in duration; 95% confidence interval, CI: 1.01-2.33). Severe ROP was associated with the presence of a patent ductus arteriosus (PDA) (OR: 3.31; 95% CI: 1.11-9.90) and birth in time period 3 versus time periods 1 and 2 combined (OR: 6.28; 95% CI: 2.10-18.74). BPD was associated with duration of mechanical ventilation (OR: 2.71 per 1-wk increment in duration; 95% CI: 1.76-4.18) and with the presence of any obstetric complication (OR: 2.67; 95% CI: 1.07-6.65). Gestational age and birthweight were not associated with major morbidity. Of all survivors, 81% were discharged home without severe IVH, PVL or severe ROP.

CONCLUSIONS:

Increased survival as a result of active perinatal and neonatal management was associated with favourable morbidity rates compared with those in recent studies. Among survivors born at 23-25 weeks, neither gestational age nor birthweight was a significant determinant of major morbidity.

• Authors: F Serenius, U Ewald, A Farooqi, P A Holmgren, S Håkansson, G Sedin
• Journal: Acta paediatrica (Oslo, Norway : 1992) (Acta Paediatr) Vol. 93 Issue 8 Pg. 1090-7 (Aug 2004) ISSN: 0803-5253 [Print] Norway
• PMID: 15456201 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Analysis of Variance
• Female
• Humans
• Infant, Newborn
• Infant, Premature
• Infant, Very Low Birth Weight
• Intensive Care, Neonatal
• Logistic Models
• Male
• Morbidity
• Perinatal Care
• Pregnancy
• Retrospective Studies
• Sweden (epidemiology)