The impact of fetal compromise on outcome at the border of viability.

OBJECTIVE: Our goal was to evaluate the impact of fetal compromise on the outcome of borderline viable babies. STUDY DESIGN: All 142 babies born in our hospital from 1990 to 1995 with a gestational age of 23 to 25 weeks were included. Fetal compromise was considered present if one of the following was documented: a major anomaly, congenital sepsis, chronic intrauterine infection, intrauterine drug exposure, congenital anemia, severe growth restriction, fetal acidosis, or cardiorespiratory and neurologic depression in the delivery room. RESULTS: The 43 babies who had at least one cause of fetal compromise had a lower birth weight (p < 0.001), but there were no other differences in demographics or complications of prematurity. The survival rate was significantly better for babies free of fetal compromise (75% vs 33%, p < 0.001), particularly for babies born at 23 weeks of gestation (75% vs 6%, p < 0.001). For surviving babies free of fetal compromise, the outcome at 23 weeks was comparable to that at 24 to 25 weeks for major causes of long-term neurologic morbidity. CONCLUSIONS: Like advancing gestational age and increasing birth weight, the absence of fetal compromise has a major beneficial impact on the outcome of borderline viable babies that might be important when decisions are made about the appropriate level of support.

Incidence and severity of intraventricular hemorrhage: 1981-1984.

We have examined the trend in the incidence and mortality of intraventricular hemorrhage (IVH) in low birthweight infants from 1981 through 1984. During this time we admitted 407 infants in the first week of life with a birthweight less than or equal to 1500 gm in whom a cranial ultrasonogram or autopsy had been performed. Though the mean birthweight and gestational age, proportion of infants who were inborn, and percentage of infants requiring mechanical ventilation did not change over the 4 years, cesarean deliveries were performed more frequently (P less than .001). The overall incidence of IVH was 62% in 1981, 56% in 1982, 49% in 1983, and 58% in 1984, thus no significant trend was evident. Although the incidence of minor hemorrhages (grades I and II) remained relatively constant, there was a decrease in the incidence of grade III IVH (1981, 11%; 1984, 2%, P = .01). The incidence of grade IV hemorrhage did not change during the 4 years and ranged from 7 to 9%. Mortality rate for all infants weighing less than or equal to 1500 gm and for infants with a minor hemorrhage remained unchanged; however, the mortality rate for infants with a major hemorrhage (grade III or IV) tended to decrease (P = .07). We conclude that although some minor changes in the incidence and mortality have occurred, IVH continues to be a major problem in very-low-birthweight infants at our institution.