OUTCOMES OF EXTREMELY LOW-BIRTH-WEIGHT INFANTS

Background. Our goal was to determine the effects of recent changes in delivery room and neonatal care, including surfactant and dexamethaso ne therapy, on survival, neonatal morbidity, and 20-month neurodevelop mental outcome of infants with birth weights of less than 750 g. Metho ds. We compared the outcomes of 114 infants of 500 to 750 g birth weig ht delivered at our perinatal center between January 1990 and December 1992 (period II), when surfactant and postnatal dexamethasone were us ed, with the outcomes of 166 such infants born between July 1982 and J une 1988 (period I). Results. The rate of cesarean section increased f rom 17% to 27% and delivery room intubation increased from 54% to 72% during periods I and II, respectively. Survival increased from 23% dur ing period I to 43% during period II. The increase in survival was sig nificant at birth weights of 600 to 700 g and at 24 weeks' gestation a nd greater. During period II fewer infants died at less than 24 hours of age and more died at more than 28 days of life. Neonatal morbidity did not change appreciably; neither did 20-month neurodevelopmental ou tcomes. Twenty percent of the infants had subnormal cognitive function (Mental Development Indices <70) and 10% had cerebral palsy during pe riod II. Conclusions. Despite an increase in survival during 1990 to 1 992, the neonatal and early childhood outcomes of the survivors were u nchanged. Physicians and parents anticipating the delivery of extremel y low birth weight infants must be aware of these outcomes to make inf ormed decisions as to the advisability of aggressive care at birth and thereafter.