Extremely pretem infants in Tunisia: Where are we now?
##plugins.themes.academic_pro.article.main##
Abstract
Extremely preterm infants are newborns born before 28 weeks of gestation. Survival of these immature newborns depends on resuscitation and the quality of care during hospitalization.
Objective: To determine survival and neurologic outcomes at2 years after extremely preterm birth.
Methods:It is a retrospective multicentric study in 5 neonatal intensive care units (NICU) in 2012-2013.All live births less than 28 weeks gestation were included.
Results:A total of 109 births were recorded. Prenatal corticosteroids were given in 47% of cases. Mean weight was 989g and mean age was 26 weeks gestation. Ninety percent of patients had respiratory distress syndrome and 67% of them needed respiratory support. Surfactant was given to 29% of newborns. The mortality rate atdischarge was 76%.The first cause of mortality was nosocomial infections. At thecorrected age of 2 years, 27% of survivors had abnormal neurologic outcome.
Conclusion:In our study, survival and neurologic outcomes ofextremely preterm infants were poor.In this high-risk population, improving perinatal care remains a challenge to improve long-term outcome in Tunisia.
Keywords:
Extremely preterm infants- Resuscitation-Morbidity-Mortality-Disability.##plugins.themes.academic_pro.article.details##
References
- Larroque B, Ancel PY, Marret S, et al. Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study. Lancet 2008;371:813-20.
- Hogan L, Ingemarsson I, Thorngren-Jerneck K, et al. How often is a low 5-min Apgar score in term newborns due to asphyxia? Eur J ObstetGynecolReprodBiol 2007;130:169-75.
- Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med 2001;344:467-71.
- Fischer N, Steurer MA, Adams M, et al. Survival rates ofextremely preterm infants (gestational age < 26 weeks) inSwitzerland: impact of the Swiss guidelines for the care ofinfants born at the limit of viability. Arch Dis Child FetalNeonatal Ed 2009;94:F407-13.
- BoussicaultaG, Brangerb B, Savagnerc C , RozéJ-C.Survival and neurologic outcomes after extremely preterm birth. Arch Pediatr .2012;19:381-390
- Fily A, Pierrat V, Delporte V, et al. Factors associated with neurodevelopmental outcome at 2 years after very preterm birth: the population-based Nord-Pas-de-Calais EPIPAGE cohort. Pediatrics 2006;117:357-66.
- Larroque B, Breart G, Kaminski M, et al. Survival of very preterm infants: Epipage, a population based cohort study. Arch Dis Child FetalNeonatal Ed 2004;89:F139-44.
- Larroque B. EPIPAGE : étude épidémiologique sur les petits âges gestationnels. Protocole de l'enquête. Arch Pediatr 2000;7(Suppl. 2):339-42.
- Bodeau-Livinec F, Marlow N, Ancel PY, et al. Impact of intensive care practices on short-term and long-term outcomes forextremely preterm infants: comparison between the British Isles and France. Pediatrics 2008;122:e1014-21.
- Vanhaesebrouck P, Allegaert K, Bottu J, et al. The EPIBEL study: outcomes to discharge from hospital for extremely preterm infants in Belgium. Pediatrics 2004;114:663-75.
- Rijken M, Stoelhorst GM, Martens SE, et al. Mortality and neurologic, mental, and psychomotor development at 2 years in infants born less than 27 weeks' gestation: the Leidenfollow-up project on prematurity. Pediatrics 2003;112:351-8.
- Malloy MH. Impact of cesarean section on neonatal mortality rates among very preterm infants in the United States, 2000-2003. Pediatrics 2008;122:285-92.
- Arpino C, Brescianini S, Ticconi C, et al. Does cesarean section prevent mortality and cerebral ultrasound abnormalities in preterm newborns? J Matern Fetal Neonatal Med 2007;20:151-9.