Journal article
Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g
JAMA pediatrics, Vol.173(5), pp.434-445
05/01/2019
DOI: 10.1001/jamapediatrics.2019.0180
PMCID: PMC6503635
PMID: 30907941
Abstract
Birth weight (BW) is an important predictor of mortality and morbidity. At extremely early gestational ages (GAs), BW may influence decisions regarding initiation of resuscitation.
To characterize outcomes of liveborn infants with a BW less than 400 g.
This retrospective multicenter cohort study analyzed extremely preterm infants born between January 2008 and December 2016 within the National Institute of Child Health and Human Development Neonatal Research Network. Infants with a BW less than 400 g and a GA of 22 to 26 weeks were included. Active treatment was defined as the provision of any potentially lifesaving intervention after birth. Survival was analyzed for the entire cohort; neurodevelopmental impairment (NDI) was examined for those born between January 2008 and December 2015 (birth years with outcomes available for analysis). Neurodevelopmental impairment at 18 to 26 months' corrected age (CA) was defined as a Bayley Scales of Infant and Toddler Development, Third Edition, cognitive composite score less than 85, a motor composite score less than 85, moderate or severe cerebral palsy, gross motor function classification system score of 2 or greater, bilateral blindness, and/or hearing impairment. Data were analyzed from September 2017 to October 2018.
Birth weight less than 400 g.
The primary outcome was survival to discharge among infants who received active treatment. Analysis of follow-up data was limited to infants born from 2008 to 2015 to ensure children had reached assessment age. Within this cohort, neurodevelopmental outcomes were assessed for infants who survived to 18 to 26 months' CA and returned for a comprehensive visit.
Of the 205 included infants, 121 (59.0%) were female, 133 (64.9%) were singletons, and 178 (86.8%) were small for gestational age. Almost half (101 of 205 [49.3%]) received active treatment at birth. A total of 26 of 205 infants (12.7%; 95% CI, 8.5-18.9) overall survived to discharge, and 26 of 101 actively treated infants (25.7%; 95% CI, 17.6-35.4) survived to discharge. Within the subset of infants with a BW less than 400 g and a GA of 22 to 23 weeks, 6 of 36 actively treated infants (17%; 95% CI, 6-33) survived to discharge. Among infants born between 2008 and 2015, 23 of 90 actively treated infants (26%; 95% CI, 17-36) survived to discharge. Two infants died after discharge, and 2 were lost to follow-up. Thus, 19 of 90 actively treated infants (21%; 95% CI, 13-31) were evaluated at 18 to 26 months' CA. Moderate or severe NDI occurred in 14 of 19 infants (74%).
Infants born with a BW less than 400 g are at high risk of mortality and significant morbidity. Although 21% of infants survived to 18 to 26 months' CA with active treatment, NDI was common among survivors.
Details
- Title: Subtitle
- Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g
- Creators
- Jane E Brumbaugh - Mayo Clinic in FloridaNellie I Hansen - RTI InternationalEdward F Bell - University of IowaAmaanti Sridhar - RTI InternationalWaldemar A Carlo - University of Alabama at BirminghamSusan R Hintz - Stanford UniversityBetty R Vohr - Brown UniversityTarah T Colaizy - University of IowaAndrea F Duncan - The University of Texas Health Science Center at HoustonMyra H Wyckoff - The University of Texas at DallasMichelle L Baack - Sanford HealthMatthew A Rysavy - University of IowaSara B DeMauro - University of PennsylvaniaBarbara J Stoll - The University of Texas Health Science Center at HoustonAbhik Das - RTI InternationalRosemary D Higgins - National Institutes of HealthNational Institute of Child Health and Human Development Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- JAMA pediatrics, Vol.173(5), pp.434-445
- DOI
- 10.1001/jamapediatrics.2019.0180
- PMID
- 30907941
- PMCID
- PMC6503635
- ISSN
- 2168-6203
- eISSN
- 2168-6211
- Grant note
- UG1 HD040689 / NICHD NIH HHS UG1 HD087226 / NICHD NIH HHS UG1 HD027904 / NICHD NIH HHS T32 GM007337 / NIGMS NIH HHS U10 HD040689 / NICHD NIH HHS UG1 HD087229 / NICHD NIH HHS UG1 HD027853 / NICHD NIH HHS UG1 HD027880 / NICHD NIH HHS
- Language
- English
- Date published
- 05/01/2019
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984354041902771
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