Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 144 No. 3940 (2014)

Outcome of extremely low gestational age newborns (ELGANs) following a pro-active treatment approach

  • Davide Morgillo
  • Jane Morgillo-Mitchell
  • Matteo Fontanta
  • Martina Steurer
  • Thomas Schmitt-Mechelke
  • Florian Bauder
  • Thomas M. Berger
Cite this as:
Swiss Med Wkly. 2014;144:w14014


QUESTIONS UNDER STUDY: To determine the impact of a pro-active treatment approach on outcome of extremely low gestational age neonates (ELGANs; gestational age [GA] <28 weeks) born at the perinatal centre of Lucerne, Switzerland.

METHODS: We assessed rates of survival, severe neonatal morbidity and neuro-developmental impairment (NDI) of all ELGANs born alive and treated at our centre between 2000 and 2009. The results were compared with published data from contemporary national and international cohorts.

RESULTS: Over the 10-year study period, a total of 216 ELGANs were born alive at the perinatal centre of Lucerne. The survival rate was 74% for all live-born infants, and 81% for those admitted to the neonatal intensive care unit. Among the 160 survivors, 25% sustained at least one major neonatal morbidity; severe brain injury (i.e., periventricular/intraventricular haemorrhage grade 3 or 4 and/or cystic periventricular leukomalacia) affected 10%; moderate or severe bronchopulmonary dysplasia 16%; retinopathy of prematurity ≥ stage 3 1%; and necrotising enterocolitis 2%. Neuro-developmental outcome data at 18 to 24 months was available for 92% of all survivors: 88% had no or mild NDI, whereas moderate and severe NDI were present in 10% and 2%, respectively.

CONCLUSION: When compared with published national or international data, our pro-active treatment approach to ELGANs was associated with higher or equal survival rates without increasing rates of severe neonatal morbidity or neuro-developmental impairment at the age of 18 to 24 months.


  1. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et al. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol. 2007;196:147.e1–8.
  2. Håkansson S, Farooqi A, Holmgren PA, Serenius F, Högberg U. Proactive management promotes outcome in extremely preterm infants: a population-based comparison of two perinatal management strategies. Pediatrics 2004;114:58–64.
  3. EXPRESS Group. Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS). Acta Paediatr. 2010;99:978–92.
  4. Lorenz JM, Paneth N, Jetton JR, Ouden den L, Tyson JE. Comparison of management strategies for extreme prematurity in New Jersey and the Netherlands: outcomes and resource expenditure. Pediatrics. 2001;108:1269–74.
  5. Wilson-Costello D, Friedman H, Minich N, Fanaroff AA, Hack M. Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants in the 1990s. Pediatrics. 2005;115:997–1003.
  6. Lefebvre F, Glorieux J, St-Laurent-Gagnon T. Neonatal survival and disability rate at age 18 months for infants born between 23 and 28 weeks of gestation. Am J Obstet Gynecol. 1996;174:833–8.
  7. O'Shea TM, Klinepeter KL, Goldstein DJ, Jackson BW, Dillard RG. Survival and developmental disability in infants with birth weights of 501 to 800 grams, born between 1979 and 1994. Pediatrics. 1997;100:982–6.
  8. Jacobs SE, O'Brien K, Inwood S, Kelly EN, Whyte HE. Outcome of infants 23–26 weeks' gestation pre and post surfactant. Acta Paediatr. 2000;89:959–65.
  9. The Victorian Infant Collaborative Study Group. Improved outcome into the 1990s for infants weighing 500–999 g at birth. The Victorian Infant Collaborative Study Group. Arch Dis Child Fetal Neonatal Ed. 1997;77:F91–4.
  10. Hack M, Fanaroff AA. Outcomes of children of extremely low birthweight and gestational age in the 1990s. Semin Neonatol. 2000;5:89–106.
  11. Cuttini M, Nadai M, Kaminski M, Hansen G, de Leeuw R, Lenoir S, et al. End-of-life decisions in neonatal intensive care: physicians' self-reported practices in seven European countries. EURONIC Study Group. Lancet. 2000;355:2112–8.
  12. Berger TM, Fauchère JC, Holzgreve W, Kind C, Largo R, Moessinger A, et al. Empfehlungen zur Betreuung von Frühgeborenen an der Grenze der Lebensfähigkeit (Gestationsalter 22–26 SSW). Schweizer Ärztezeitung. 2002;83:1589–95. German.
  13. Berger TM, Bernet V, Alama El S, Fauchère JC, Hösli I, Irion O, et al. Perinatal care at the limit of viability between 22 and 26 completed weeks of gestation in Switzerland. Swiss Med Wkly. 2011;141:w13280
  14. Fischer N, Steurer MA, Adams M, Berger TM, Swiss Neonatal Network. Survival rates of extremely preterm infants (gestational age <26 weeks) in Switzerland: impact of the Swiss guidelines for the care of infants born at the limit of viability. Arch Dis Child Fetal Neonatal Ed. 2009;94:F407–13.
  15. Berger TM, Steurer MA, Woerner A, Meyer-Schiffer P, Adams M, Swiss Neonatal Network. Trends and centre-to-centre variability in survival rates of very preterm infants (<32 weeks) over a 10–year-period in Switzerland. Arch Dis Child Fetal Neonatal Ed. 2012;97:F323–8.
  16. International Classification of Diseases (ICD) 10th revision. World Health Organization [Homepage on the Internet]. 2013 ed. Available from:
  17. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92:529–34.
  18. de Vries LS, Eken P, Dubowitz LM. The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res. 1992;49:1–6.
  19. International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123:991–9.
  20. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187:1–7.
  21. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723–9.
  22. Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol. 2005;47:571–6.
  23. Bayley N. Bayley scales of infant development. 2nd edition. San Antonio (TX). The Psychological Corporation; 1993. German version, G. Reuner, J. Rosenkranz, J. Pietz, R. Horn, Pearsson 2008.
  24. Griffiths R. The abilities of babies: a study in mental measurment. Association for Research in Infants and Child Development. Amersham, UK; 1976. German version, I. Brandt, E.J. Sticker, 2nd revised and enlarged edition, Beltz Test GmbH 2001.
  25. Tyson JE, Parikh NA, Langer J, Green C, Higgins RD, National Institute of Child Health and Human Development Neonatal Research Network. Intensive care for extreme prematurity – moving beyond gestational age. N Engl J Med. 2008;358:1672–81.
  26. Cole TJ, Hey E, Richmond S. The PREM score: a graphical tool for predicting survival in very preterm births. Arch Dis Child Fetal Neonatal Ed. 2010;95:F14–9.
  27. Medlock S, Ravelli ACJ, Tamminga P, Mol BWM, Abu-Hanna A. Prediction of mortality in very premature infants: a systematic review of prediction models. PLoS ONE. 2011;6:e23441.
  28. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010;126:443–56.
  29. Ge WJ, Mirea L, Yang J, Bassil KL, Lee SK, Shah PS, et al. Prediction of neonatal outcomes in extremely preterm neonates. Pediatrics. 2013;132:e876–85.
  30. Boland RA, Davis PG, Dawson JA, Doyle LW, The Victorian Infant Collaborative Study Group. Predicting death or major neurodevelopmental disability in extremely preterm infants born in Australia. Arch Dis Child Fetal Neonatal Ed. 2013;98:F201–4.
  31. Schlapbach LJ, Adams M, Proietti E, Aebischer M, Grunt S, Borradori-Tolsa C, et al. Outcome at two years of age in a Swiss national cohort of extremely preterm infants born between 2000 and 2008. BMC Pediatr. 2012;12:198.
  32. Mercier CE, Dunn MS, Ferrelli KR, Howard DB, Soll RF, Vermont Oxford Network ELBW Infant Follow-Up Study Group. Neurodevelopmental outcome of extremely low birth weight infants from the Vermont Oxford network: 1998–2003. Neonatology. 2010;97:329–38.
  33. EXPRESS Group, Fellman V, Hellström-Westas L, Norman M, Westgren M, Källén K, et al. One-year survival of extremely preterm infants after active perinatal care in Sweden. JAMA. 2009;301:2225–33.
  34. Serenius F, Källén K, Blennow M, Ewald U, Fellman V, Holmström G, et al. Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden. JAMA. 2013;309:1810–20.
  35. Berger TM, Fontana M, Stocker M. The journey towards lung protective respiratory support in preterm neonates. Neonatology. 2013;104:265–74.
  36. Sola A, Golombek S, Bueno MTM, Lemus-Varela L, Zuluaga C, Domínguez F, et al. Safe oxygen saturation targeting and monitoring in preterm infants. Can we avoid hypoxia and hyperoxia? Acta Paediatr. 2014; [Epub ahead of print]
  37. Fowlie PW, Davis PG, McGuire W. Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants. Fowlie PW, editor. Cochrane Database Syst Rev. Chichester, UK: John Wiley & Sons, Ltd; 2010;7:CD000174.
  38. Gordon PV. Understanding intestinal vulnerability to perforation in the extremely low birth weight infant. Pediatr Res. 2009;65:138–44.
  39. Ramani M, Ambalavanan N. Feeding practices and necrotizing enterocolitis. Clin Perinatol. 2013;40:1–10.
  40. Quigley M, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Quigley M, editor. Cochrane Database Syst Rev. Chichester, UK: John Wiley & Sons, Ltd. 2014;4:CD002971.
  41. Sisk PM, Lovelady CA, Dillard RG, Gruber KJ, O'Shea TM. Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J Perinatol. 2007;27:428–33.

Most read articles by the same author(s)