Prediction of survival for preterm births by weight and gestational age: retrospective population based study

BMJ 1999;319:1093-1097 ( 23 October )

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Prediction of survival for preterm births by weight and gestational age: retrospective population based study

Elizabeth S Draper, senior research fellow in perinatal epidemiology, ^a Bradley Manktelow, medical statistician, ^a David J Field, professor of neonatal medicine, ^b David James, professor of fetomaternal medicine. ^c

^a Department of Epidemiology and Public Health, Leicester University Medical School, Leicester LE1 6TP, ^b Department of Child Health, Leicester Royal Infirmary, Leicester LE2 7LX, ^c Department of Obstetrics and Gynaecology, Queens Medical Centre, University of Nottingham, Nottingham NG7 2UH

Correspondence to: E S Draper msn{at}le.ac.uk

Objective: To produce current data on survival of preterminfants.
Design: Retrospective population basedstudy.
Setting: Trent healthregion.
Subjects: All European and Asian live births, stillbirths,and late fetal losses from 22 to 32 weeks' gestation, excludingthose with major congenital malformations, in women resident inthe Trent health region between 1 January 1994 and 31 December1997.
Main outcome measures: Birth weight and gestational age specificsurvival for both European and Asian infants (a) known to be aliveat the onset of labour, and (b) admitted for neonatalcare.
Results: 738 deaths occurred in 3760 infants born between22 and 32 weeks' gestation during the study period, giving anoverall survival rate of 80.4%. The survival rate for the 3489(92.8%) infants admitted for neonatal care was 86.6%. For Europeaninfants known to be alive at the onset of labour, significantvariations in gestation specific survival by birth weight emergedfrom 24 weeks' gestation: survival ranged from 9% (95% confidenceinterval 7% to 13%) for infants of birth weight 250-499 g to 21%(16% to 28%) for those of 1000-1249 g. At 27 weeks' gestation,survival ranged from 55% (49% to 61%) for infants of birth weight500-749 g (below the 10th centile) to 80% (76% to 85%) for thoseof 1250-1499 g. Infants who were large for dates ( $>=$ 27 weeks' gestation)had a slightly reduced, but not significant, predicted survival.Similar survival rates were observed for Asian infants. The oddsratio for the survival of infants from a multiple birth comparedwith singleton infants was 1.4 (1.1 to 1.8). Survival graphs forinfants admitted for neonatal care are presented bysex.
Conclusion: Easy to use birth weight and gestational agespecific predicted survival graphs for preterm infants facilitatedecision making for clinicians and parents. It is important thatthese graphs are representative, are produced for a geographicallydefined population, and are not biased towards the outcomes ofparticular centres. Such graphs, produced in two stages, allowfor the changing pattern of survival of infants from the startof the intrapartum period to immediately after admission for neonatalcare.

Key messages

Birth weight and gestational age specific predicted survival graphs for preterm infants facilitate decision making for clinicians and parents
Survival graphs should be representative and not biased towards the outcomes of particular centres
Period specific graphs allow for the changing pattern of survival from the start of the intrapartum period to the immediate period after admission for neonatal care
Causes of preterm delivery in singletons may lead to a poorer survival rate (controlled for gestation and birth weight) than those precipitated by multiple pregnancy
Survival graphs need regular updating to allow for improvements in survival of infants

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