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.
