title: Neonatal outcome of extremely preterm Asian infants ⩽28 weeks over a decade in the new millennium.
abstract: OBJECTIVE
  To evaluate predischarge neonatal mortality and morbidity and associated risk factors in extremely preterm Asian infants ⩽28 weeks, over a decade, so as to facilitate formulation of perinatal guidelines and counseling.
  
  
  METHODS
  Cohort study of 887 liveborn extremely preterm neonates between 2000 and 2009 at KKH, the centralized perinatal center in Singapore. Outcome measures were predischarge mortality, presence of one or more major neonatal morbidities and the composite outcome of mortality or neonatal morbidity.
  
  
  RESULTS
  Overall survival to discharge was 709/887 (80%) and was significantly higher with increasing gestational age (GA) (19% at 23 weeks to 93% at 28 weeks, P<0.001). Survival remained unchanged between 78 and 86% during the decade with no significant secular trend. Overall incidence of major morbidities were bronchopulmonary dysplasia (29%), late onset sepsis (23%), severe retinopathy of prematurity (21%), Grade 3 to 4 intraventricular hemorrhage (12%) and necrotizing enterocolitis ⩾Bells' stage II/focal intestinal perforation (9%). Composite morbidity was seen in 465/835 (56%) neonatal intensive-care unit admissions, decreased with increasing GA (P<0.001; odds ratio 0.65 (95% confidence interval 0.56 to 0.75) and was independently predicted by birth weight, Clinical Risk Index for Babies-revised version II score, male gender, presence of patent ductus arteriosus and airleaks.
  
  
  CONCLUSIONS
  Although there was no significant trend in neonatal survival or composite morbidity over the decade, improved survival and morbidity were seen with increasing GA.
authors: Department of Neonatology, KK Women's and Children's Hospital, Singapore.
authors: P
authors: P
authors: Agarwal
authors: Department of Neonatology, KK Women's and Children's Hospital, Singapore.
authors: B
authors: B
authors: Sriram
authors: Department of Neonatology, KK Women's and Children's Hospital, Singapore.
authors: V S
authors: VS
authors: Rajadurai
mesh_terms: D001724:Birth Weight; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology*; D015331:Cohort Studies; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D009017:Morbidity; D015999:Multivariate Analysis; D016017:Odds Ratio; D012178:Retinopathy of Prematurity / Q000453:epidemiology*; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D012846:Singapore / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends*; D062606:Tertiary Care Centers
references: Pediatrics. 2009 Jan;123(1):313-8
references: 19117897
references: Arch Dis Child Fetal Neonatal Ed. 2004 Sep;89(5):F419-22
references: 15321961
references: Arch Dis Child Fetal Neonatal Ed. 2009 May;94(3):F158-63
references: 18805823
references: Pediatrics. 2004 Sep;114(3):663-75
references: 15342837
references: J Matern Fetal Neonatal Med. 2008 Feb;21(2):115-21
references: 18240080
references: Lancet. 2003 May 24;361(9371):1789-91
references: 12781540
references: BMJ. 2008 May 31;336(7655):1221-3
references: 18469017
references: Arch Dis Child Fetal Neonatal Ed. 2009 Nov;94(6):F407-13
references: 19357122
references: Arch Ophthalmol. 2005 Jul;123(7):991-9
references: 16009843
references: Dev Med Child Neurol. 2009 Nov;51(11):895-900
references: 19416333
references: Pediatrics. 2012 Jan;129(1):124-31
references: 22184652
references: BMC Pediatr. 2003 Dec 16;3:13
references: 14678563
references: Aust N Z J Obstet Gynaecol. 2011 Jun;51(3):204-9
references: 21631437
references: BMJ. 2012 Dec 04;345:e7976
references: 23212881
references: Obstet Gynecol. 2002 Sep;100(3):617-24
references: 12220792
references: Pediatrics. 2005 May;115(5):1289-98
references: 15867037
references: Pediatrics. 2010 Sep;126(3):443-56
references: 20732945
references: J Perinatol. 2012 Feb;32(2):132-8
references: 21593814
references: Arch Pediatr Adolesc Med. 2012 Jun 1;166(6):543-50
references: 22312168
references: Pediatrics. 2012 Aug;130(2):270-8
references: 22778301
references: Acta Paediatr. 2009 Apr;98(4):648-53
references: 19133870
references: Conn Med. 1998 Mar;62(3):131-7
references: 9573649
references: Acta Paediatr. 2009 Sep;98(9):1451-5
references: 19575767
references: JAMA. 2003 Mar 5;289(9):1124-9
references: 12622582
references: JAMA. 2009 Jun 3;301(21):2225-33
references: 19491184
references: Am J Obstet Gynecol. 2007 Feb;196(2):147.e1-8
references: 17306659
references: Pediatrics. 2009 Jul;124(1):112-21
references: 19564290
references: Pediatrics. 2009 Feb;123(2):445-50
references: 19171608
references: Semin Perinatol. 2003 Dec;27(6):458-70
references: 14740944
references: Arch Dis Child Fetal Neonatal Ed. 2012 Sep;97(5):F323-8
references: 22933089
references: JAMA. 2004 Nov 17;292(19):2357-65
references: 15547163
references: Clin Perinatol. 2010 Jun;37(2):339-54
references: 20569811
references: Obstet Gynecol. 2012 Apr;119(4):795-800
references: 22433343
references: Pediatrics. 2008 Jan;121(1):e193-8
references: 18166538
references: J Am Coll Surg. 2002 Dec;195(6):796-803
references: 12495312
references: Pediatrics. 2007 Jan;119(1):e257-63
references: 17200251
references: Pediatrics. 2007 Jan;119(1):29-36
references: 17200268
references: Pediatrics. 2001 Jan;107(1):E1
references: 11134465
references: Pediatrics. 1963 Nov;32:793-800
references: 14075621
references: Arch Dis Child Fetal Neonatal Ed. 2005 Mar;90(2):F128-33
references: 15724036
references: Semin Fetal Neonatal Med. 2012 Feb;17(1):20-5
references: 21865101
references: N Engl J Med. 2008 Apr 17;358(16):1672-81
references: 18420500
references: Am J Respir Crit Care Med. 2001 Jun;163(7):1723-9
references: 11401896
references: Arch Dis Child Fetal Neonatal Ed. 2001 Mar;84(2):F79-84
references: 11207220
references: Obstet Gynecol. 2002 Jan;99(1):159-67
references: 16175681