THE RELATION OF MATERNAL COMPLICATIONS TO OUTCOMES IN VERY-LOW-BIRTH-WEIGHT INFANTS IN AN ERA OF CHANGING NEONATAL CARE

We examine the relation of key neonatal outcomes to pregnancy complica tions and to the use of antenatal steroids and investigate whether the re is evidence of recent change in this relation. Complete information on pregnancy and neonatal course was available for 749 out of 949 sin gleton births without major congenital anomalies below 1501 g admitted to seven regional neonatal intensive care units between August 1, 198 8 and June 30, 1991. Mortality was highest in infants born after labor with spontaneous rupture of fetal membranes of less than 24 hours dur ation (odds ratio [OR]=1.6, 95% confidence interval [1.0,2.6]). Sponta neous rupture of membranes of over 24 hours duration was associated wi th decreased risk of respiratory distress syndrome (OR=0.42, [0.28,0.6 4]) and decreased risk of patent ductus arteriosus (OR=43, [0.28,0.66] ). Pregnancy induced hypertension was associated with increased risk o f respiratory distress syndrome in those born at less than 30 weeks' g estation (OR=6.0, [2.0,17]). Labor with or without rupture of membrane s of short duration was associated with increased risk of intraventric ular hemorrhage (OR= 1.9, [1.2,2.5]). These associations were not diff erent in early versus late time periods of the study. Antenatal steroi ds were associated with dramatically reduced risk of mortality (OR=0.2 0, [0.09,0.50]), respiratory distress syndrome (OR=0.52, [0.32,0.85]), and intraventricular hemorrhage (OR=0.37, [0.21-0.65]).