ASPHYXIA IN VERY LOW BIRTH WEIGHT (VLBW) INFANTS: VARIATIONS BETWEEN LEVELS OF HOSPITAL CARE

Abstract

Level II perinatal centers often lack personnel support to provide immediate resuscitative care for preterm infants. To examine the magnitude of this problem on the incidence of perinatal asphyxia in VLBW, (<1500 g) infants we analyzed the distribution of maternal and infant variables, VLBW frequency, total and VLBW perinatal and neonatal mortality rates (PMR, NMR) and Apgar score distributions among 59, 739 births which occurred between 1982-85. The prospective data collection system in 10 Level II and 2 Level III centers is an ongoing monitoring programme. Our data (Table) show that in spite of a two fold increase in VLBW rate in Level III centers, their VLBW NMR/PMR, and the incidence of severe asphyxia (Apgar<3) were significantly lower than in Level II. In Level II centers 48% of VLBW infants were severely asphyxiated at 1 minute of age, but more significantly, one in one half of such infants had not improved by 5 minutes of age (P<0.05 as compared to Level III). We conclude that in addition to transferring high risk mothers and/or infants to Level III, Level II centers should also strive to maintain continued educational services regarding neonatal resuscitation to avoid asphyxia in VLBW infants.