Short term outcome after active obstetric management of very low birthweight infants

UNLABELLED: Increased survival in infants weighing less than 1500g (VLBW) in recent decades is largely due to active perinatal management and intensive neonatal care. AIMS: To analyze the relationship between antenatal corticosteroid (ACS) administration, mode of delivery and the short term outcome in VLBW infants. METHODS: A total of 563 neonates weighing < 1500 g was studied between 01.01.2008 and 30.06.2010, distributed according the outcome into 3 groups: 330 healthy, 150 with chronic morbidities (bronchopulmonary dysplasia - supplemental O2 at 28 days, intraventricular hemorrhage gr.Ill-IV or cystic periventricular leucomalacia, retinopathy of prematurity gr.llI-V), 83 died. Mode of delivery, ACS and their influence on the outcome were evaluated by multinomial logistic regression analysis and the relative risk was calculated for each of them (OR). The ACS course was taken for completed if applicated in the 7 days before delivery. RESULTS: Lack of ACS significantly increased the risk of severe morbidities or death compared to the complete course: OR 2.6 and 4.9 respectively (p < 0.001). A higher risk was found comparing incomplete to complete course too: morbidities OR 2,3 (p = 0.01), death OR 3,1 (p = 0.01). Incomplete ACS did not improved outcome significantly. Mode of delivery didn't affected significantly the risk of morbidities. The relative risk of death was lower in neonates delivered by cesarean section compared with vaginal breech delivery (OR 0.2, p = 0.005) but higher compared with vaginal vertex delivery (OR 2.1, p = 0,004). In this study we didn't analyze the indications for cesarean section, some of which were due to fetal distress and could influence the outcome. CONCLUSION: The active obstetric management for VLBW infants reduces the risk of death and survival with morbidities. The main protective factor is the complete ACS course.