138 The Nonimpact of Post-1994 Neonatal Technology on IUGR Preterm Newborns

Abstract

Background: Widespread use of steroids and surfactant since the mid-1990s has improved survival for premature newborns (PN). Survival and neurodevelopmental outcomes are less favorable in the intrauterine growth restricted (IUGR) subset of premature newborns. Since 1983 our institution has cared for 398 IUGR PN with birth weights (BW) </= 900g including the worlds two smallest surviving newborns (280g female,1989; 260g female, 2004). We sought to compare survival among these IUGR PN before and after the advent of widespread use of steroids and surfactant.Methods: Our retrospective study included newborns with gestational age (GA) >/= 22 wks, BW </=900g and weight </=10th %ile for GA. Statistical analysis: survival to discharge:z-ratio; BW and GA: student t-test.Results: Newborns enrolled: 1983–94 (n=214) 1995–2004 (n=184) Survival to discharge: 1983–94 (61.2%) 1995–2004 (67.9%) p=0.16 Mean GA (wks): 1983–94 (27.5) 1995–2004 (27.1) p=0.17 BW (g): 1983–94 (662) 1995–2004 (639) p=0.14Conclusions: Despite widespread use of antenatal/postnatal steroids and surfactant after 1994, we failed to find a significant increase in survival among the IUGR PN. We hypothesize that the stresses associated with IUGR may preclude an additional benefit from antenatal steroid therapy. We will examine possible benefits of management strategies often employed in our NICU while caring for IUGR PN. These strategies include: Ventilator management: set physiologic rates of 40–60 breaths per minute, wean inspiratory pressures as tolerated, keep oxygen saturations 86%–89%, use HFOV as rescue only, no elective extubation <700g; Pulmonary: 3–5 day steroid burst if requiring FiO2>/= 0.50 at 7 days of life; Sedation/analgesia: scheduled around-the-clock sedation for first week of life; Hematology: maintain hematocrit >/= 40 if FiO2 >/= 0.50 for a duration >72 hours.