MORTALITY, MODE OF DELIVERY, PNEUMOTHORAX AND INTRACRANIAL HEMORRHAGEIN 859 VERY-LOW-BIRTH-WEIGHT INFANTS BETWEEN 1984-1992

In a retrospective study we investigated the mortality and the most im portant complications of all very low birth-weight infants (VLBW; less than or equal to 1500 g and/or less than or equal to 32 weeks) born w ith vital signs between 1984 and 1992 at the Klinikum Grosshadern, Mun ich University Hospital. During this period 859 premature infants fulf illed the entrance criteria. The perinatal mortality rate was 174/859 infants (20%). During the study period the mortality rate dropped sign ificantly from 25% (1984-1986) to 15% (1990-1992). Premature infants b orn after 26 gestational weeks showed the most significant decrease in mortality. Excluding non viable infants with extreme immaturity (<24 weeks of gestation) or lethal malformations, the mean corrected mortal ity rate was 11%, decreasing over the years from 76% (1984-1985) to 5% (1990-1992). Caesarean section was performed in 70% of all children ( 602/859), vaginal delivery in 28% (239/859), delivery by forceps in 1% (7/859), and the mode of delivery was not clearly registrated in 1% ( 11/859). The incidence of Caesarean section increased significantly fr om 55% (1984-86) to 79% (1990-92). Evaluating the mode of delivery in relation to mortality, a significant difference was found between the infants delivered vaginally (40%, 95/239) and those delivered by Caesa rean section (11%, 67/602). This improved survival after Caesarean sec tion was statistically significant for the group with a birth weight o f less than 1500 g. The rate of pneumothorax also declined significant ly from 79% to 9%. The rate of intracranial haemorrhage (ICH) remained almost constant during these years, but the incidence of ICH grade 3 and 4 decreased from 15% (1984-1986) to 6% (1990-1992). Probably becau se of improved antenatal care and the progress in neonatal intensive c are, the chance of survival for VLBW infants has substantially improve d over the last decade. Estimations of the prognosis of VLBW infants b ased on data from the 1980 s are out of date.