Fused Eyelids in the Extremely Premature Infant: Multivariate Analysis of Survival and Outcome

ABSTRACT

The presence of fused eyelids at birth in the extremely low birthweight infant (less than 1000 gm) is often regarded by physicians as an indication of nonviability. This is especially true for the pediatrician who does not have routine exposure to extremely premature infants and may use the presence of fused eyelids to influence the level of resuscitation afforded the infant in the first crucial minutes following birth. Unfortunately, there are scant data in the literature to guide general pediatricians with regard to this issue. The purpose of this study was to examine, with the aid of multivariate statistical analysis, the survival and combined outcome score in extremely premature infants with and without fused eyelids. The combined outcome was a composite of several outcome variables (intraventricular hemorrhage, bronchopulmonarydysplesia, and retinopathyof prematurity); survival was defined employing the standard definition of neonatal survival, that is, alive at 28 days post natal age. Combined outcome and survival were analyzed with regard to several independent variables (birthweight, gestational age, and 5-minute Apgar scores, mode of delivery, race, sex, and maternal age). A regression analysis was performed to determine the effect of the independent variables on the combined outcome. A separate multivariate logistic regression analysis was employed to determine the effect of the same independent variables on neonatal survival. The results indicate that eyelid status alone was not associated with a lower survival (p = 0.14) and a poorer combined outcome (p = 0.20) and that other covariant factors had a higher association with survival (birthweight, p = 0.05; gestational age = 0.02; and sex, p = 0.01) and outcome (1-minute Apgar score, p = 0.02). We conclude that eyelid status should not be used in isolation to determine provision of neonatal resuscitative efforts to these infants.