The extremely low birthweight infant: the twenty-first century dilemma.
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, weighting 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.