FACTORS INFLUENCING SURVIVAL AND EARLY PR OGNOSIS OF VERY-LOW-BIRTH-WEIGHT PREMATURES (LESS-THAN-OR-EQUAL-TO-1500 G)

Prognostic factors influencing survival in 235 very low birthweight pr ematures (less than or equal to 1500 g) born between 1986 and 15.11.19 93 at the Department of Obstetrics and Gynaecology, University Hospita l of Cologne, were retrospectively evaluated. Chromosomal anomalies an d severe congenital malformations were excluded. Of 180 singletons 84 were classified as appropriate-for-gestational-age (AGA) and 96 as sma ll-for-gestational-age (SGA). By interrogating the attending paediatri cians data regarding the early development of 62/65 surviving singleto ns born between 1986 to 1990 were recorded (follow-up rate 95 %). Surv ival was significantly correlated to singleton pregnancy (p < 0.05), f emale sex (p = 0.001) and in the AGA-prematures to prenatal corticoid prophylaxis. With similar mean birthweight SGA-singletons showed a thr ee weeks higher mean gestational age; the mortality showed an inverse correlation to birthweight and gestational age being 11 % higher in th e AGA-group compared with the SGA-group (32 % versus 21 %). At the age of between 11 months and 6 years severe handicaps and developmental r etardations were found more often in previous AGA-prematures (6/26) th an in previous SGA-prematures (4/36); type and degree of later handica p were not correlated to birthweight. According to our results sur viv al rates of very low birthweight prematures are strongly influenced by singleton pregnancy, by fetal sex, by gestational age and in the AGA- group by prenatal corticoid prophylaxis; mortality shows an inverted c orrelation to birthweight and gestational age, whereas the later progn osis of survivors does not seem to be influenced by birthweight or ges tational age.