[Mortality, mode of delivery, pneumothorax and intracranial hemorrhage in 859 extremely premature newborn infants between 1984-1992].

In a retrospective study we investigated the mortality and the most important complications of all very low birth-weight infants (VLBW; < or = 1500 g and/or < or = 32 weeks) born with vital signs between 1984 and 1992 at the Klinikum Grosshadern, Munich University Hospital. During this period 859 premature infants fulfilled the entrance criteria. The perinatal mortality rate was 174/859 infants (20%). During the study period the mortality rate dropped significantly from 25% (1984-1986) to 15% (1990-1992). Premature infants born after 26 gestational weeks showed the most significant decrease in mortality. Excluding non viable infants with extreme immaturity ( < 24 weeks of gestation) or lethal malformations; the mean corrected mortality rate was 11%, decreasing over the years from 16% (1984-1986) to 5% (1990-1992). Caesarean section was performed in 70% of all children (602/859), vaginal delivery in 28% (239/859), delivery by forceps in 1% (7/859), and the mode of delivery was not clearly registrated in 1% (11/859). The incidence of Caesarean section increased significantly from 55% (1984-86) to 79% (1990-92). Evaluating the mode of delivery in relation to mortality, a significant difference was found between the infants delivered vaginally (40%, 95/239) and those delivered by Caesarean section (11%, 67/602). This improved survival after Caesarean section was statistically significant for the group with a birth weight of less than 1500 g. The rate of pneumothorax also declined significantly from 19% to 9%. The rate of intracranial haemorrhage (ICH) remained almost constant during these years, but the incidence of ICH grade 3 and 4 decreased from 15% (1984-1986) to 6% (1990-1992). Probably because of improved antenatal care and the progress in neonatal intensive care, the chance of survival for VLBW infants has substantially improved over the last decade. Estimations of the prognosis of VLBW infants based on data from the 1980s are out of date.