The impact of fetal compromise on outcome at the border of viability,☆☆,

Presented at the Sixty-sixth Annual Meeting of the Society of Pediatric Research, Washington, D.C., May 3, 1997.
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Abstract

OBJECTIVE: Our goal was to evaluate the impact of fetal compromise on the outcome of borderline viable babies. STUDY DESIGN: All 142 babies born in our hospital from 1990 to 1995 with a gestational age of 23 to 25 weeks were included. Fetal compromise was considered present if one of the following was documented: a major anomaly, congenital sepsis, chronic intrauterine infection, intrauterine drug exposure, congenital anemia, severe growth restriction, fetal acidosis, or cardiorespiratory and neurologic depression in the delivery room. RESULTS: The 43 babies who had at least one cause of fetal compromise had a lower birth weight (p < 0.001), but there were no other differences in demographics or complications of prematurity. The survival rate was significantly better for babies free of fetal compromise (75% vs 33%, p < 0.001), particularly for babies born at 23 weeks of gestation (75% vs 6%, p < 0.001). For surviving babies free of fetal compromise, the outcome at 23 weeks was comparable to that at 24 to 25 weeks for major causes of long-term neurologic morbidity. CONCLUSIONS: Like advancing gestational age and increasing birth weight, the absence of fetal compromise has a major beneficial impact on the outcome of borderline viable babies that might be important when decisions are made about the appropriate level of support. (Am J Obstet Gynecol 1998;178:909-15.)

Section snippets

Methods

All babies born at our hospital from Jan. 1, 1990, through Dec. 31, 1995, who were 23 to 25 completed weeks of gestation by obstetric estimate were included in this review. Ninety-eight percent of these mothers received prenatal care. The obstetric estimate of gestational age was based on postmenstrual dates and supported by prenatal ultrasonography in 92% of the cases. Physical examination of the baby was used to establish gestational age only if no prenatal data were available.

A list of

Results

During the study period 142 babies from 23 to 25 completed weeks of gestation were born alive at our hospital, and all babies were included in the study. By our criteria 99 were free of fetal compromise, whereas 43 had at least one additional fetal problem (Table I).

. Diagnoses for 43 babies with fetal compromise*

DiagnosisNo. of babies
Severe cardiorespiratory and neurologic depression upon delivery20
Congenital anemia16
Severe intrauterine growth restriction7
Cord acidosis6
Congenital sepsis2
Major

Comment

We realize that unique features of our population (98% of mothers received prenatal care and 99% of infants were intubated in the delivery room) may make it difficult to generlize our results to other populations. Neveretheless, our data support the idea that for our population, in addition to gestational age and birth weight, the prenatal condition of the baby is an important determinant of outcome for borderline viable babies. In this retrospective study we attempted to identify those babies

Acknowledgements

We acknowledge the thoughtful review of Dr. M. Jeffrey Maisels.

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    From the Division of Newborn Medicine, Department of Pediatrics, William Beaumont Hospital.

    ☆☆

    Reprint requests: Daniel G. Batton, MD, William Beaumont Hospital–Royal Oak, 3601 W. 13 Mile Road, Royal Oak, MI 48073-6769.

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