INCIDENCE OF PREMATURE BIRTH AND NEONATAL RESPIRATORY-DISEASE IN INFANTS OF HIV-POSITIVE MOTHERS

Objective: We sought to determine the prematurity rate in infants of H IV-positive mothers and to characterize the incidence and severity of neonatal respiratory disease in this population. Study design: From 19 90 to 1994, 600 live-born infants of HIV-infected mothers were enrolle d prenatally (73%) or postnatally (27%) from five U.S. centers. Logist ic regression was used to determine the association of HIV status in t he infant with prematurity (less than or equal to 37 weeks), low birth weight (less than or equal to 2.5 kg), and very low birth weight (les s than or equal to 1.5 kg) rates. The incidence of respiratory distres s syndrome (RDS), bronchopulmonary dysplasia, meconium aspiration synd rome, and neonatal pneumonia was compared with anticipated rates for g estational age and birth weight. Results: Very high rates of prematuri ty (19%), low birth weight (18.3%), and very low birth weight (3.3%) w ere found in the infants of HIV-positive mothers; and HIV infection in the infant was associated with younger gestational age. The overall i ncidence of RDS was 3% (17/600), which coincided with the anticipated rate, after adjusting for prematurity and birth weight. Only five infa nts (all less than or equal to 1.5 kg) had bronchopulmonary dysplasia, and none required assisted ventilation beyond 14 days. Three term inf ants had mild meconium aspiration syndrome, and there were no cases of documented neonatal pneumonia. Conclusion: Infants born to HIV-positi ve mothers exhibited high prematurity and low birth weight rates, and the odds of prematurity were higher in infants who were infected with HIV. Despite the high incidence of prematurity and perinatal risk of t his population, incidence and severity of neonatal respiratory disease were not higher than would be expected from available neonatal data i n populations not exposed to HIV.