Outcomes of very low birth weight infants at Prapokklao Hospital in the first four years of the new millennium.

Abstract

Background : Very low birth weight infants (weighing less than 1500 g) have higher morbidity and mortality rates than normal full term infants. Almost all of these infants need special care and treatments such as neonatal intensive care. Recently, new sophisticated equipments especially mechanical ventilators for infants have developed and there is now a greater chance of survival for these infants.Prapokklao Hospital is a regional hospital in Eastern of Thailand and a lot of very low birth weight infants were admitted to neonatal unit but the outcomes of these infants have never been evaluated.

Objectives : Our purpose was to determine mortality and morbidity rates of infants weighing less than 1500 g, who were admitted to our hospital from 2000 to 2003

Methods : This study was a retrospective longitudinal descriptive design. Information on all very low birth weight admissions to the neonatal intensive care unit at Prapokklao Hospital between January 2000 and December 2003 was collected and analyzed. Multiple logistic regression analysis was done to demonstrate the adjusted odds ratios (OR) and 95 percent confidence intervals (CI) for the
independent risk factors on mortality

Results : The number of very low birth weight infants admissions was 206. The incidence of very low birth weight infants at Prapokklao Hospital was 1.4 percent of life births and the mortality rate of these infants was 36.6 percent. The survived group had significant mean birth weight higher than the non-survived group (p<.05). Extremely low birth weight infants (ELBW, weighing less than 1000 g) had significant higher mortality rate than very low birth weight infants (VLBW,weighing 1000-1499) (OR = 9.338 CI = 4.488 - 19.427). Most of the non-survived group of ELBW died in the first week of life. (0 - 7 days: 84.2 percent, 8 - 28 days: 10.5 percent and >28 days: 5.3 percent). 64.4 percent of the infants needed mechanical ventilators with no significant difference between ELBW and VLBW (OR = .653, CL = .341- 1.249). The most common complications found in our study were sepsis, patent ductus arteriosus ,bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity and cholestasis, respectively and were more common in the survived ELBW than in the survived VLBW.Multiple logistic regression analyses were performed, using mortality as the dependent variable and host factors, birth factors, treatments and complications as predictor variables. Birth weight (OR = 1.001, CI = 1.001-1.007), apgar at 5 minutes (OR = 1.412, CI = 1.087-1.835), no mechanical ventilation (OR= 3.170,CI = 1.129-8.900), pulmonary air leak (OR = 11.608, CI = 2.978-45.242) and patient ductus arteriosus (OR = 1.303, CI = 0.325-5.218) showed the association with mortality.

Conclusions : Compared with reports from other developed countries, VLBW infants at our center had higher mortality rate. There were interaction between mortality rate and birth weight, birth asphyxia and complications. To improve the survival rates, appropriate intensive care for the neonates is necessary. For these, besides the sophisticated modern hardwares, the standard nursing cares and
improvement of the staffs should be intensely concerned.