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PEDIATRICS Vol. 113 No. 6 June 2004, pp. 1559-1566

Fetal Infants: The Fate of 4172 Infants With Birth Weights of 401 to 500 Grams—The Vermont Oxford Network Experience (1996–2000)

Jerold F. Lucey, MD*,{ddagger}, Cherise A. Rowan, MD*, Patricia Shiono, PhD{ddagger}, Andrew R. Wilkinson, MB, ChB§, Sarah Kilpatrick, MD, PhD||, Nathaniel R. Payne, MD, Jeffrey Horbar, MD*,{ddagger}, Joseph Carpenter, MS{ddagger}, Jeannette Rogowski, PhD# and Roger F. Soll, MD*,{ddagger}

* Department of Pediatrics, College of Medicine, University of Vermont, Burlington, Vermont
{ddagger} Vermont Oxford Network, Burlington, Vermont
§ Department of Pediatrics, University of Oxford, Oxford, United Kingdom
|| University of Illinois at Chicago, Chicago, Illinois
Children’s Healthcare, Minneapolis, Minnesota
# RAND, Washington, DC

Objective. Improvement in the survival of extremely low birth weight infants requires that we evaluate the limits of our care and assess the impact of treatment on a population of infants who previously rarely survived.

Methods. A review was conducted of demographic and clinical data of infants who had birth weight 401 to 500 g and were entered in the Vermont Oxford Network Database between 1996 and 2000.

Results. A total of 4172 infants who weighed 401–500 g (mean gestational age: 23.3 ± 2.1 weeks) were born at 346 participating centers. Overall, 17% survived until discharge. A total of 2186 (52%) died in the delivery room (DR), and 1986 (48%) were admitted to a neonatal intensive care unit (NICU). Compared with infants who died in the DR, infants who survived the DR and were admitted to the NICU were more likely to be female (58% vs 49%), to be small for gestational age (56% vs 11%), to have received prenatal steroids (61% vs 12%), and to have been delivered by cesarean section (55% vs 5%). Thirty-six percent of NICU admissions survived to discharge. Mean gestational age of the 690 NICU survivors was 25.3 ± 2.0 weeks. These survivors experienced significant morbidity in the NICU.

Conclusions. An appreciable number of these marginally viable fetal infants survive. They experienced a high rate of serious morbidities while in the NICU. There is very little information about long-term outcomes, as the medical and developmental status of few of these infants has been followed carefully. Parents should be made aware of the high incidence of serious problems, and concerted efforts should be made to follow the status of these infants.

Key Words: fetal infants • extremely low birth weight infants • extremely low gestational age infants • neonatal intensive care nursery • neonatal outcomes

Abbreviations: VON, Vermont Oxford Network • NICU, neonatal intensive care unit • DR, delivery room • SGA, small for gestational age • ROP, retinopathy of prematurity

Received for publication Oct 31, 2003; Accepted Feb 3, 2004.


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