CHANGING TREND IN PERINATAL MANAGEMENT AND OUTCOME OF EXTREMELY LOW-BIRTH-WEIGHT (ELBW) INFANTS

Perinatal care of the extremely preterm and low birthweight (ELBW) inf ant is founded on basic principles of physiology and knowledge about t he prevailing pathophysiological mechanisms. New therapies in clinical care are usually introduced non-uniformly, so more often there is a g radual rather than a sudden change in the development of perinatal car e, conceivably involving also an important learning process. This was confirmed in an evaluation of respiratory care for ELBW infants (n = 3 25) over a 9-year period (1986-1991). Although birthweight (mean 815 g ) and degree of immaturity at birth (mean 26.7 weeks of gestation) did not change over the years, our trend analysis showed that the surviva l rate increased from 47% to 70% (p < 0.04) and the percentage of surv ivors without bronchopulmonary dysplasia and/or major intracranial hae morrhages (ICH grades 3 and 4) increased from 67% to 87% (p < 0.006). mie suggest that besides medical treatment per se, refinement and tuni ng of nursing and medical care procedures will also affect the total o utcome of ELBW infants.