Journal article
Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018
JAMA : the journal of the American Medical Association, Vol.327(3), pp.248-263
01/18/2022
DOI: 10.1001/jama.2021.23580
PMCID: PMC8767441
PMID: 35040888
Abstract
Despite improvement during recent decades, extremely preterm infants continue to contribute disproportionately to neonatal mortality and childhood morbidity.
To review survival, in-hospital morbidities, care practices, and neurodevelopmental and functional outcomes at 22-26 months' corrected age for extremely preterm infants.
Prospective registry for extremely preterm infants born at 19 US academic centers that are part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. The study included 10 877 infants born at 22-28 weeks' gestational age between January 1, 2013, and December 31, 2018, including 2566 infants born before 27 weeks between January 1, 2013, and December 31, 2016, who completed follow-up assessments at 22-26 months' corrected age. The last assessment was completed on August 13, 2019. Outcomes were compared with a similar cohort of infants born in 2008-2012 adjusting for gestational age.
Extremely preterm birth.
Survival and 12 in-hospital morbidities were assessed, including necrotizing enterocolitis, infection, intracranial hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia. Infants were assessed at 22-26 months' corrected age for 12 health and functional outcomes, including neurodevelopment, cerebral palsy, vision, hearing, rehospitalizations, and need for assistive devices.
The 10 877 infants were 49.0% female and 51.0% male; 78.3% (8495/10848) survived to discharge, an increase from 76.0% in 2008-2012 (adjusted difference, 2.0%; 95% CI, 1.0%-2.9%). Survival to discharge was 10.9% (60/549) for live-born infants at 22 weeks and 94.0% (2267/2412) at 28 weeks. Survival among actively treated infants was 30.0% (60/200) at 22 weeks and 55.8% (535/958) at 23 weeks. All in-hospital morbidities were more likely among infants born at earlier gestational ages. Overall, 8.9% (890/9956) of infants had necrotizing enterocolitis, 2.4% (238/9957) had early-onset infection, 19.9% (1911/9610) had late-onset infection, 14.3% (1386/9705) had severe intracranial hemorrhage, 12.8% (1099/8585) had severe retinopathy of prematurity, and 8.0% (666/8305) had severe bronchopulmonary dysplasia. Among 2930 surviving infants with gestational ages of 22-26 weeks eligible for follow-up, 2566 (87.6%) were examined. By 2-year follow-up, 8.4% (214/2555) of children had moderate to severe cerebral palsy, 1.5% (38/2555) had bilateral blindness, 2.5% (64/2527) required hearing aids or cochlear implants, 49.9% (1277/2561) had been rehospitalized, and 15.4% (393/2560) required mobility aids or other supportive devices. Among 2458 fully evaluated infants, 48.7% (1198/2458) had no or mild neurodevelopmental impairment at follow-up, 29.3% (709/2419) had moderate neurodevelopmental impairment, and 21.2% (512/2419) had severe neurodevelopmental impairment.
Among extremely preterm infants born in 2013-2018 and treated at 19 US academic medical centers, 78.3% survived to discharge, a significantly higher rate than for infants born in 2008-2012. Among infants born at less than 27 weeks' gestational age, rehospitalization and neurodevelopmental impairment were common at 2 years of age.
Details
- Title: Subtitle
- Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018
- Creators
- Edward F Bell - University of IowaSusan R Hintz - Stanford UniversityNellie I Hansen - RTI InternationalCarla M Bann - RTI InternationalMyra H Wyckoff - The University of Texas Southwestern Medical CenterSara B DeMauro - University of PennsylvaniaMichele C Walsh - Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentBetty R Vohr - Brown UniversityBarbara J Stoll - Children's Healthcare of AtlantaWaldemar A Carlo - University of Alabama at BirminghamKrisa P Van Meurs - Stanford UniversityMatthew A Rysavy - Department of Pediatrics, University of Texas at Houston, Houston.Ravi M Patel - Children's Healthcare of AtlantaStephanie L Merhar - University of CincinnatiPablo J Sánchez - Nationwide Children's HospitalAbbot R Laptook - Brown UniversityAnna Maria Hibbs - Case Western Reserve UniversityC Michael Cotten - Duke UniversityCarl T D'Angio - University of RochesterSarah Winter - University of UtahJanell Fuller - University of New MexicoAbhik Das - RTI InternationalEunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.327(3), pp.248-263
- DOI
- 10.1001/jama.2021.23580
- PMID
- 35040888
- PMCID
- PMC8767441
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Grant note
- L40 HD099827 / NICHD NIH HHS F32 HD098782 / NICHD NIH HHS UL1 TR003167 / NCATS NIH HHS KL2 TR003168 / NCATS NIH HHS
- Language
- English
- Date published
- 01/18/2022
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984354049402771
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