ABSTRACT
The survival rate of very low birthweight infants (weighing less than 1500 gm) has
dramatically increased over the past two decades. Consequently, high-tech intensive
care is offered to an increasing number of infants with borderline viability, previously
considered as miscarriages. We reviewed the most recent literature on the results
of intensive care used in the subgroup of extremely low birthweight infants, weighing
less than 750 gm or 800 gm. Since definitions, management policies, and follow-up
reports in this group of newborns are not consistent, the important statistical variables
of incidence, mortality, and morbidity are incomplete and severely biased. In the
past decade there was a growing tendency toward using a more active approach in caring
for these infants. Most of the success is among the infants weighing 750 to 800 gm,
with a survival rate in the range of 33 to 62%. However, the overall improvement in
survival is small, with an extremely poor outlook for infants below 600 gm. The morbidity
rate in the survivors is alarmingly high, reaching 70% and most common in infants
with birthweight less than 600 gm. The available data show that virtually for every
“healthy” surviving extremely low birthweight infant there is also at least one surviving
child who is moderately to severely handicapped. The overall consequences and implications
of high-tech care of these borderline viability infants, once considered as nonviable,
are not necessarily improved over those of the former, less aggressive, approach.
Since these results have grave consequences for the involved families and society,
we urgently need to involve these parties more actively in decision making.
