Very-low-birthweight outcomes of the National Institute of Child Health and Human Development Neonatal Network, November 1989 to October 1990

Article Abstract:

Outcomes for infants weighing 1500 g or less at birth improved during the period from 1987-1988 to 1989-1990 among the participating centers of the National Institute of Child Health and Human Development Research Network. However, serious complication and disability rates were still high. In 1989-1990, 39% of infants weighing less than 751 g survived, increasing to 77% of infants weighing 751 to 1000 g, 90% of infants weighing 1001 to 1250 g, and 93% of infants weighing 1251 to 1500 g. Overall, 40% of infants experienced brain hemorrhage, 24% developed septicemia, 22% had patent ductus arteriosis, and 8% developed necrotizing enterocolitis. Compared with 1987-1988, survival rates improved substantially in the 600 g to 1000 g subgroup without a similar increase in serious complication rates. The introduction of surfactant treatment is believed to be one factor responsible. Prenatal treatment with steroids, cesarean section delivery, and steroid treatment for chronic lung disease may also have played a role.

Prognosis, Infants (Premature), Birth weight, Low, Premature infants, Low birth weight

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Prenatal and perinatal risk and protective factors for neonatal intracranial hemorrhage

Article Abstract:

Corticosteroid therapy given before birth along with several other factors appears to protect against severe intracranial hemorrhage (ICH) among low birth weight infants. ICH is bleeding or the presence of blood clots within the head. Researchers analyzed the medical records of 4795 low birth weight single birth infants born between November 1987 and January 1991 for risk factors associated with ICH. Ten percent of these infants had grade III ICH and 7% had grade IV ICH. Older infants, female infants, and higher weight infants were less likely to have grade III or grade IV ICH. Mothers taking prenatal corticosteroids, those with high blood pressure, and African-American mothers were less likely to give birth to an infant with severe ICH. The incidence of ICH as well as infant death associated with ICH fell during this time period from 19% to 15% and 15% to 11%, respectively.

Risk factors, Infants (Newborn), Newborn infants, Brain, Brain hemorrhage

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Relationship between antenatal steroid administration and grades III and IV intracranial hemorrhage in low birth weight infants

Article Abstract:

Administration of corticosteroids before delivery appears to reduce the incidence of severe intracranial hemorrhage (ICH) in neonates weighing between 501 and 1500 gm. Corticosteroids improve fetal maturation. Registry information on 4,665 infants from seven university medical centers was analyzed. Cranial sonography was used to diagnose ICH. Incidence of ICH dropped from 18% to 8% in infants receiving a full course of prenatal steroid therapy, and dropped to 14% in patients receiving a partial course. Corticosteroids may stabilize arterial blood pressure, accelerate the maturation of neuronal cells, and increase lung maturity. It is recommended that antenatal steroids be administered before delivery to women 24 to 34 weeks' gestation.

Care and treatment, Prevention, Corticosteroids, Adrenocortical hormones, Premature birth

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