Background Advances in obstetric and neonatal practice have potentially increased survival at the limits of viability and in severely growth restricted infants. In the UK, the proportion of liveborn infants weighing <500 g increased from 0.1 to 0.2% between 2004 and 2010.^1,2

Aim To provide short-term morbidity and mortality data for infants weighing <500 g from one tertiary neonatal unit.

Methods Infants with birth weight <500g admitted between January 2004 and December 2013 identified, notes reviewed and outcomes quantified.

Results There were 26 admissions with birth weight <500 g over the ten year period. Outborn infants and those with major congenital anomaly were excluded (n = 4). Gestational age ranged from 22+3 to 28+2 weeks and birth weight from 358 to 495 g. 91% received antenatal steroids, 73% were delivered by caesarean section and 100% received surfactant. There are two groups of infants: appropriately grown (n = 9) and severely growth restricted (n = 13).

14 of 22 infants survived to discharge (64%). Of the surviving infants, 93% were receiving breast milk at full feeds, 21% had intraventricular haemorrhage (IVH) (maximum grade 2) and 86% required home oxygen. Of the infants who died, two had grade 3 or 4 IVH and two had necrotising enterocolitis.

Conclusion Infants with birth weight <500 g are a rarely reported group. This case series reports 64% survival, in contrast to 18% from Europe¹ and 20% from the USA.³ These outcome data highlight increasing ethical dilemmas in the management of this group.

References

1. European perinatal health report 2008. www.europeristat.com. Accessed 10/12/13

2. European perinatal health report 2010. www.europeristat.com. Accessed 10/12/13

3. Lau C, et al. Pediatrics 2013:131:855–859