Is it possible to improve “Limits Of Viability” for extreme preterm infants born in Developing Countries? ♦ 1354

Abstract

The answer to “How small is too small?/How early is too early?” has changed substantially in industrialized nations where the survival of extreme preterm babies has improved significantly in the last decade. No such data exists for developing nations. The objective of this study is to report mortality and morbidity for inborn infants with birth weight (B.W.) < 1000g between 11/92-10/97. These NICU's are not equipped with “state of the art” technological equipment but infants are cared by specialized neonatal nurses, with high nurse to patient ratio and rigorous continuity of medical care, provided directly by full time staff. A total of 53 infants < 1000g (0.6% of all live births) were born in this period. The mothers were from middle-upper socio-economic class and all received prenatal care. B.W. was 751±135gr (r:500-1000); G.Age: 26±2 wks (r:22-34); SGA:18%; C-section: 78%. Corrected survival (excluding 3 NB with severe malformations) was 90% (45/50). Survival according to B.W. and G.Age is shown below. Of all infants, 68% received antenatal steroids, 88% received IMV, 52% had RDS and 48% received surfactant; 58% had PDA and 8% required surgical ligation; 44% had CLD (O2 at 36 wks post-conc. age) and 14% went home with O2. Only 6% had NEC; 20% had IVH (III-IV); 10% had severe ROP. The prevalence of nosocomial infection was 36%. The survival rate of 90% at this extreme of viability is as high as the rates published recently in units from developed nations. However, the incidence of CLD is higher. This may be related to many factors, which we are now exploring. On the other hand, the incidence of NEC not only was extremely low, but there was no need for surgery nor deaths related to NEC. We speculate that this is related to prenatal steroids and to the feeding protocol used, which provides very early “gut stimulation” exclusively with human milk and carefully controlled slow advance. Even though these results may not be representative of current results for extreme prematures in developing countries, they provide evidence that the limits of viability for these infants can be improved with adequate prenatal care and with emphasis placed on human resources in NICU. Table