J Korean Med Sci.  2021 Aug;36(31):e206. 10.3346/jkms.2021.36.e206.

Survival and Morbidities in Infants with Birth Weight Less than 500 g: a Nationwide Cohort Study

• Hwang JH
• Jung E
• Lee BS
• Kim EAR
• Kim KS

• KMID: 2519201
• DOI: http://doi.org/10.3346/jkms.2021.36.e206

Abstract

Background
This study aimed to investigate the survival and morbidities of infants in the Korean Neonatal Network (KNN) with birth weight (BW) < 500 g.
Methods
The demographic and clinical data of 208 live-born infants with a BW < 500 g at a gestational age of ≥ 22 weeks who were treated in the neonatal intensive care units of the KNN between 2013 and 2017 were reviewed.
Results
The survival rate of the infants was 28%, with a median gestational age and BW of 24 3/7 weeks (range, 22 0/7 –33 6/7 ) and 440 g (range, 220–499), respectively. Multivariable Cox proportional hazards analysis demonstrated that survival to discharge was associated with longer gestation, higher BW, female sex, singleton gestation, use of any antenatal corticosteroids, and higher Apgar scores at 5 minutes. The overall survival rates were significantly different between the BW categories of < 400 g and 400–499 g. However, there was no significant difference in the incidence of any morbidity between the BW groups. Half of the deaths of infants with BW < 500 g occurred within a week of life, mainly due to cardiopulmonary and neurologic causes. The major causes of death in infants after 1 week of age were infection and gastrointestinal disease. Among the surviving infants, 79% had moderate to severe bronchopulmonary dysplasia, 21% underwent surgical ligation of patent ductus arteriosus, 12% had severe intraventricular hemorrhage (grade III–IV), 38% had sepsis, 9% had necrotizing enterocolitis (stage ≥ 2), and 47% underwent laser treatment for retinopathy of prematurity. The median length of hospital stay was 132 days (range, 69–291), and 53% required assistive devices at discharge.
Conclusion
Despite recent advances in neonatal intensive care, the survival and morbidity rates of infants with BW < 500 g need further improvement.

Keyword

Extremely Low Birth Weight Infants; Preterm Infant; Outcome; Survival; Complication

Figure

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  Fig. 1 Flow chart of the study design for patient enrollment.BW = birth weight, KNN = Korean Neonatal Network, GA = gestational age.

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  Fig. 2 Survival rates of the infants with birth weight less than 500 g by the Kaplan-Meier method.

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  Fig. 3 Causes of death in infants with birth weight less than 500 g according to the timing of death.

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