Poor outcomes at discharge among extremely premature infants: a national population-based study.
OBJECTIVE
To assess risk factors and develop a simple estimate method for poor neonatal outcomes for specific groups of extremely premature infants at birth.


METHODS
Population-based study.


METHODS
Israel National Very Low Birth Weight Infant Database.


METHODS
Infants born at 23 to 26 weeks' gestation between January 1, 1995, and December 31, 2008.


METHODS
We developed a tool to estimate poor neonatal outcomes for infants born at 24 to 26 weeks' gestation (n=2544) that incorporated factors at birth significantly associated with poor outcomes into a linear regression model.


METHODS
Poor neonatal outcomes defined as the composite of mortality or severe neurologic or pulmonary morbidity at discharge from the hospital.


RESULTS
Major factors associated with poor outcomes at 24 to 26 weeks' gestation were gestational age, male sex, sex-specific birth weight percentile, and lack of prenatal steroid therapy. Estimated poor outcomes for January 1, 2000, to December 31, 2008, were calculated as the sum of the percentages determined for each of the 4 parameters: (1) gestational age (26, 25, and 24 weeks; 0%, 17%, and 34%, respectively), (2) birth weight percentile (>75th, 25th-75th, and < 25th percentiles; 0%,13%, and 26%, respectively), (3) lack of prenatal steroids (16%), and (4) male sex (7%). There was also an intercept value of 25%. Estimated poor outcome rates for the 36 subgroups of infants ranged from 25% to 100%and correlated well with observed rates (intraclass correlation coefficient, 0.93).


CONCLUSIONS
The combined outcomes of deaths or severe morbidities in the neonatal period of infants born at 24 to 26 weeks' gestation could be simply estimated at birth. The provision of an appropriate and up-to-date estimate of poor neonatal outcomes for specific infants may be useful in counseling families on treatment options for these infants.
Department ofNeonatology, Bnai Zion Medical Center, 47 Golomb St, Haifa, Israel. dramir@netvision.net.il
Amir
A
Kugelman
David
D
Bader
Liat
L
Lerner-Geva
Valentina
V
Boyko
Orna
O
Levitzki
Arieh
A
Riskin
Brian
B
Reichman
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000401:mortality; D019102:Infant, Very Low Birth Weight; D007557:Israel; D008297:Male; D010351:Patient Discharge; D011295:Prenatal Care; D012307:Risk Factors; D015996:Survival Rate
D000305:Adrenal Cortex Hormones