title: Changing outcome of extremely premature infants (less than or equal to 26 weeks' gestation and less than or equal to 750 gm): survival and follow-up at a tertiary center.
abstract: Management of extremely premature infants is controversial because limits of viability are not established. From 1981 to 1987, 175 infants were admitted to the neonatal intensive care unit at Minneapolis Children's Medical Center with gestational ages less than or equal to 26 weeks and birth weights less than or equal to 750 gm. To assess current prognosis and to analyze trends over time, survival data and developmental characteristics of surviving infants were reviewed. During the study period, antenatal obstetric management was assertive, with liberal indications for tocolysis and expectant management for preterm prolonged membrane rupture, with the goal of delivery of infants in a nonasphyxiated condition. Ninety-one percent of infants were inborn and were managed aggressively after birth with full neonatal support. Survival increased from 21% in 1981-1982 to greater than 50% in 1986-1987 and occurred as early as 23 weeks' gestation. Seventy-one percent of all deaths occurred within 48 hours of birth, and late death (greater than 28 days) was uncommon. At follow-up, 23% of survivors were impaired, a proportion that remained relatively constant during the study period. Improvements in survival were not associated with an increased proportion of impaired infants. Survival with good outcome is attainable at gestational ages and birth weights previously considered nonviable. For obstetricians, neonatologists, and parents, knowledge of such current data can play an important role in making appropriate management decisions for both mother and infant.
authors.affiliation: Division of Neonatology, Abbott-Northwestern Hospital, Minneapolis, MN.
authors.forename: T B
authors.initials: TB
authors.lastname: Ferrara
authors.forename: R E
authors.initials: RE
authors.lastname: Hoekstra
authors.forename: E
authors.initials: E
authors.lastname: Gaziano
authors.forename: G E
authors.initials: GE
authors.lastname: Knox
authors.forename: R J
authors.initials: RJ
authors.lastname: Couser
authors.forename: J J
authors.initials: JJ
authors.lastname: Fangman
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology; D007234:Infant, Premature; D008297:Male; D009017:Morbidity