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A Journal on Pediatrics, Neonatology, Adolescent Medicine,
Child and Adolescent Psychiatry
Indexed/Abstracted in: CAB, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,532
Minerva Pediatrica 2016 Jul 13
Morbidity and mortality of preterm infants less than 26 weeks of gestational age
Maria I. DURÃES 1, Filipa FLOR-DE-LIMA 1, 2, Gustavo ROCHA 2, Henrique SOARES 1, 2, Hercília GUIMARÃES 1, 2 ✉
1 Department of Pediatrics of Faculty of Medicine of Porto University, Alameda Professor Hernâni Monteiro, Porto, Portugal; 2 Neonatal Intensive Care Unit, Department of Pediatrics, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, Porto, Portugal
BACKGROUND: Extreme preterm infants have a high risk of morbidity and mortality. Newborns delivered between 23+0 and 25+6 weeks, are considered to be in the “gray zone” and have uncertain prognosis. For these children medical decision-making becomes complex and controversial. The present study intends to evaluate the neonatal morbidity and mortality of preterm infants born between 23 weeks and 25+6 weeks of gestational age.
METHODS: A retrospective study was conducted including all inborn preterm infants, with a gestational age between 23+0 and 25+6 weeks, admitted to a level IIIC NICU, between 1st January, 1996 and 31th December, 2014.
RESULTS: A total of 72 preterm neonates were included, 18.1% had a full cycle of antenatal steroids. The most frequent major morbidities were RDS (95.4%), patent ductus arteriosus (81.3%), sepsis (55.7%, being 19.7% early sepsis, and 36.1% late sepsis), intraventricular hemorrhage (34.4%), retinopathy of prematurity (21.9%) and necrotizing enterocolitis (10.9%). Fifty-four (75%) children died. The only factor adjusted to age associated with high mortality founded was hypotension (OR=4.99, p<0.019). Morbidity at discharge was: severe bronchopulmonary dysplasia (77.8%), retinopathy of prematurity (72.2%), intraventricular hemorrhage (16.7%), cystic periventricular leukomalacia (11.1%) and necrotizing enterocolitis’ sequelae (5.6%).
CONCLUSION: The survival rate was 25% and a high morbidity at discharge was observed, which leave us with the huge responsibility to improve this result in a near future. Extreme prematurity is still a very controversial and complex issue and particular challenge for neonatologists. The use of antenatal steroid in the more immature preterm infants should be encouraged.