495 MORBIDITY AND MORTALITY OF INFANTS ≥ 2500 GMS IN A RE-FERRAL NICU

Little epidemiologic attention has been given to infants ⩾ 2500 gms. admitted to NICU's. To determine their morbidity and mortality, we reviewed all admissions for 17 months and they represented 44% (236/545) of the admissions and 37% of all deaths. The diagnoses were: Pulmonary disease (PD) other than meconium aspiration syndrome (MAS) (32%) ; asphyxia (As) (22%) ; congenital anomalies & heart disease (CA/CHD) (21%) ; surgical (11%) ; sepsis (5%) ; others (9%) . MAS occurred in 44% (22/50) of As infants. Mortality rate was 17% (40/236). Of the deaths, 70% were due to CA/CHD, 23% to As and 7% to sepsis. Of the 9 As deaths, all were > 42 wks. and 8 had MAS. Of 21 cases with persistent fetal circulation (PFC), 17 had As, 16 were > 42 wks and 7 (33%) died. In infants with PFC, As and MAS who were > 42 wks, mortality was 55%. Thirty four infants (14%) were > 42 wks, 9 (27%) died. Sixty seven (28%) were ⩽ 37 wks, only 3 died (4%) & they had CA/CHD. PD other than MAS occurred in 54/67 (80%). None of the ≤37 wks. who had PD and were born by elective c-section or induction had prenatal lung maturity studies. Morbidity and mortality remains high in this group of infants. Prevention of postmaturity and better intrapartum management should significantly decrease the number of deaths. Accurate assessment of lung maturity and gestational age, in order to avoid iatrogenic prematurity, will decrease the number of infants ⩾ 2500 gms requiring neonatal intensive care.