Extremely growth-retarded infants: is there a viability centile?
BACKGROUND
It is known that extremely premature infants do less well than more mature infants, and this fact has led some countries to adopt a "cutoff for viability" using birth weight or gestation. Infants affected by intrauterine growth retardation are at additional risk of poor outcome. There are few data to inform decisions about viability and (dis)continuation of intensive care when both extreme prematurity and severe growth retardation are present.


OBJECTIVE
We focused on (1) premature infants affected by marked intrauterine growth retardation to determine if there was a cutoff weight centile below which the mortality sharply increased and (2) the short-term outcome of extremely premature and growth-retarded infants to determine a cutoff for viability.


METHODS
We evaluated preterm infants of 22-32 weeks' gestation if they were alive at the onset of labor and born to European mothers resident in the Trent (United Kingdom) health region between 1994 and 2003. Infants were categorized into 6 weight centiles, and infants in each category were assessed for survival to discharge from the neonatal unit, duration of respiratory support, length of stay in the neonatal unit, and the age at death in nonsurvivors.


RESULTS
We identified a total of 8228 infants who met the study criteria. Of these, 4448 infants were male, 6194 were from singleton pregnancies, and 2887 were born at < or = 28 completed weeks of gestation. Survival to discharge was markedly reduced in the infants born at < or = 28 weeks of gestation with a birth weight less than the 2nd centile. Stillbirth was inversely related to birth weight centile in infants born before 29 weeks of gestation.


CONCLUSIONS
The survival for infants born at < or = 28 weeks' gestation and having a birth weight in less than the 2nd centile is poor, and consideration should be given to modifying their management.
Kamoji
Vishwanath M
VM
Neonatal Unit, Level 5 Kensington Building, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, United Kingdom. vmkamoji@doctors.org.uk
Dorling
Jon S
JS
Manktelow
Bradley N
BN
Draper
Elizabeth S
ES
Field
David J
DJ
D001724:Birth Weight; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data; D016208:Databases, Factual; D003657:Decision Making; D004739:England / Q000453:epidemiology; D005260:Female; D005317:Fetal Growth Retardation / Q000401:mortality*; D005865:Gestational Age; D017052:Hospital Mortality; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007236:Infant, Small for Gestational Age; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008017:Life Expectancy; D008297:Male; D018447:Medical Futility; D009099:Multiple Birth Offspring / Q000706:statistics & numerical data; D010351:Patient Discharge; D011379:Prognosis; D016079:Refusal to Treat; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D050497:Stillbirth / Q000453:epidemiology; D016019:Survival Analysis; D044465:White People