Beyond the borderline: Outcomes for inborn infants born at ≤500 grams

Aim To report survival, morbidity and neurodevelopmental outcome in a cohort of extremely low birthweight infants. Methods Retrospective cohort study of all inborn infants born alive with birthweights ≤500 g ≥22 weeks gestation at W omen's and C hildren's H ospital, A delaide, A ustralia, over a 6‐year period (2005–2010). Outcome data including standardised medical and psychological assessments at 12 and 36 months corrected age were collated from follow‐up. Results A total of 36 eligible infants were born over the study period (mean gestational age ( GA ) 24.4 (range 22.0–30.0) weeks; birthweight 443 (330–500) grams). Twenty‐six of the 36 (72%) infants were small for gestational age ( SGA ).Ten of the 36 infants received compassionate care and died in the delivery or operating room. Twenty‐six of the 36 infants were admitted to the neonatal intensive care unit ( NICU ), of whom 12 (46%) died during their admission. At age 12 months corrected, 2/14 (14%) of survivors had none/minimal, 4/14 (29%) had mild and 8/14 (57%) had moderate/severe neurodevelopmental disability. Overall, the survival rate was 39%, and survival without neurodevelopmental disability was 6%. Only 1/10 appropriate‐for‐gestational‐age ( AGA ) infants survived to discharge (and had severe disability), whereas 13/26 (50%) of all SGA infants in the study survived to discharge. Of all infants admitted to the NICU , 11/26 (42%) survived without severe neurodevelopmental disability at latest follow‐up. Conclusions There was a high risk of death or impairment in this cohort of infants. Survival was rare for AGA infants weighing ≤500 g at birth. Our study provides an evidence base to assist counselling and decision‐making.