EFFECT OF DELIVERY ROOM CARE ON SURVIVAL AND OUTCOME OF LOW BIRTH WEIGHT INFANTS

Abstract

Neonatal survival of very low birth weight (VLBW) infants (600-999 grams) and long-term outcome of low birth weight (LBW) infants (600-1499 grams) are correlated with optimal delivery room (DR) management. Over a 4-year period, 335 LBW infants were born alive at UCHSC. Of these, 108 were VLBW. Intrapartum and resuscitation management were reviewed and rated. "Optimal delivery care" was defined as appropriate intrapartum care and a controlled, uncomplicated delivery. "Optimal resuscitation" required that a team be present at delivery and encounter no technical problems. Optimal delivery room (DR) management occurred when both obstetric and pediatric care were appropriate. Adequate information was available to rate 80% of cases. Survival of VLBW infants was significantly improved with optimal DR care (p < 0.05). DR care had the greatest impact on 700-999 grams infants. In this group, 68% of survivors had "optimal care" while only 31% of the neonatal deaths (ND) had "optimal care" (p < 0.01). Neonatal deaths also occurred later with optimal DR care (p < 0.02). Unavoidable obstetrical complications occurred in 14 deliveries of VLBW infants (11 ND and 3 survivors) (p < 0.05). All of the survivors had optimal resuscitation. Only 1 of the 3 survivors was normal at follow-up. Vaginal breech delivery of LBW infants had a significant neonatal mortality compared to vertex vaginal delivery (p < 0.01) or breech C-section delivery (p < 0.02). Optimal DR management was also associated with normal long-term outcome for LBW infants. Fifty percent with optimal DR care and 30% without were normal at follow-up (p < 0.05). With improvement in Newborn Intensive Care, the effects of intrapartum and delivery room management can now be measured in both neonatal survival and long-term outcome. These findings have special significance for level I hospitals who transport LBW infants after delivery and stabilization.