Journal article
Approach to Infants Born at 22 to 24 Weeks’ Gestation: Relationship to Outcomes of More-Mature Infants Available
Pediatrics (Evanston), Vol.129(6), pp.e1508-e1516
06/2012
DOI: 10.1542/peds.2011-2216
PMCID: PMC3362905
PMID: 22641761
Abstract
OBJECTIVE:
We sought to determine if a center’s approach to care of premature infants at the youngest gestational ages (22–24 weeks’ gestation) is associated with clinical outcomes among infants of older gestational ages (25–27 weeks’ gestation).
METHODS:
Inborn infants of 401 to 1000 g birth weight and 22 0/7 to 27 6/7 weeks’ gestation at birth from 2002 to 2008 were enrolled into a prospectively collected database at 20 centers participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Markers of an aggressive approach to care for 22- to 24-week infants included use of antenatal corticosteroids, cesarean delivery, and resuscitation. The primary outcome was death before postnatal day 120 for infants of 25 to 27 weeks’ gestation. Secondary outcomes were the combined outcomes of death or a number of morbidities associated with prematurity.
RESULTS:
Our study included 3631 infants 22 to 24 weeks’ gestation and 5227 infants 25 to 27 weeks’ gestation. Among the 22- to 24-week infants, use of antenatal corticosteroids ranged from 28% to 100%, cesarean delivery from 13% to 65%, and resuscitation from 30% to 100% by center. Centers with higher rates of antenatal corticosteroid use in 22- to 24-week infants had reduced rates of death, death or retinopathy of prematurity, death or late-onset sepsis, death or necrotizing enterocolitis, and death or neurodevelopmental impairment in 25- to 27-week infants.
CONCLUSIONS:
This study suggests that physicians’ willingness to provide care to extremely low gestation infants as measured by frequency of use of antenatal corticosteroids is associated with improved outcomes for more-mature infants.
Details
- Title: Subtitle
- Approach to Infants Born at 22 to 24 Weeks’ Gestation: Relationship to Outcomes of More-Mature Infants Available
- Creators
- Edward F Bell - Department of Pediatrics, University of Iowa, Iowa City, IowaP. Brian Smith - Department of Pediatrics, Duke University, Durham, North CarolinaNamasivayam Ambalavanan - Division of Neonatology, University of Alabama at Birmingham, Birmingham, AlabamaLei Li - RTI International, Research Triangle Park, North CarolinaC. Michael Cotten - Department of Pediatrics, Duke University, Durham, North CarolinaMatthew Laughon - Department of Pediatrics, University of North Carolina, Chapel Hill, North CarolinaMichele C Walsh - Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OhioAbhik Das - RTI International, Research Triangle Park, North CarolinaWaldemar A Carlo - Division of Neonatology, University of Alabama at Birmingham, Birmingham, AlabamaBarbara J Stoll - Department of Pediatrics, Emory University School of Medicine, and Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GeorgiaSeetha Shankaran - Department of Pediatrics, Wayne State University, Detroit, MichiganAbbot R Laptook - Department of Pediatrics, Women & Infants’ Hospital, Brown University, Providence, Rhode Island; andRosemary D Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MarylandRonald N Goldberg - Department of Pediatrics, Duke University, Durham, North CarolinaEunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- Pediatrics (Evanston), Vol.129(6), pp.e1508-e1516
- DOI
- 10.1542/peds.2011-2216
- PMID
- 22641761
- PMCID
- PMC3362905
- NLM abbreviation
- Pediatrics
- ISSN
- 0031-4005
- eISSN
- 1098-4275
- Publisher
- American Academy of Pediatrics
- Language
- English
- Date published
- 06/2012
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984093469802771
Metrics
32 Record Views