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J Pediatr. 2017 Nov;190:112-117.e3. doi: 10.1016/j.jpeds.2017.05.017. Epub 2017 Jun 1.

Early Mortality and Morbidity in Infants with Birth Weight of 500 Grams or Less in Japan.

Author information

1
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan. Electronic address: hinoue@pediatr.med.kyushu-u.ac.jp.
2
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan.
3
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Pediatrics, University of Occupational and Environment Health, Kitakyushu, Japan.
4
Comprehensive Maternity and Perinatal Care Center, Kyushu University, Fukuoka, Japan.

Abstract

OBJECTIVE:

To assess the short-term prognosis of Japanese infants with a birth weight (BW) of ≤500 g.

STUDY DESIGN:

Demographic and clinical data were reviewed for 1473 live born infants with a BW ≤500 g at gestational age ≥22 weeks who were treated in the 204 affiliated hospitals of the Neonatal Research Network of Japan between 2003 and 2012.

RESULTS:

Survival to hospital discharge occurred in 811 of 1473 infants (55%; 95% CI 53%-58%). The survival rates of BW ≤300 g, 301-400 g, and 401-500 g were 18% (95% CI 10%-31%), 41% (95% CI 36%-47%), and 60% (95% CI 57%-63%), respectively. In a multivariable Cox proportional hazards analysis, antenatal corticosteroid use (adjusted hazard ratio: 0.68; 95% CI 0.58-0.81; P < .01), cesarean delivery (0.69; 95% CI 0.56-0.85; P < .01), advanced gestational age per week (0.94; 95% CI 0.89-0.99; P = .02), BW per 100-g increase (0.55; 95% CI 0.49-0.64; P < .01), Apgar score ≥4 at 5 minutes (0.51; 95% CI 0.43-0.61; P < .01), and no major congenital abnormalities (0.38; 95% CI 0.29-0.51; P < .01) were associated with survival to discharge. Despite the improved survival rate over the 10-year study period (from 40% in 2003 [95% CI 30%-51%] to 68% in 2012 [95% CI 61%-75%]), at least 1 severe morbidity was present in 81%-89% of the survivors.

CONCLUSIONS:

Improvements in perinatal-neonatal medicine have improved the survival, but not the rate of major morbidities, of infants with a BW ≤500 g in Japan.

KEYWORDS:

complication; extremely low birth weight infants; outcome; preterm infants; survival

PMID:
28746032
DOI:
10.1016/j.jpeds.2017.05.017
[Indexed for MEDLINE]
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