Approach to Infants Born at 22 to 24 Weeks’ Gestation: Relationship to Outcomes of More-Mature Infants

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.

Etiologies of NICU Deaths

“…5,6 A substantial percentage of extremely premature infants were offered care but died despite intensive care. Recent studies demonstrate variability in the prenatal care offered to such infants 7,8 and suggest that improvements can be made. Respiratory failure, sepsis, IVH, and NEC are often the cause of death and are modifiable events (eg, through use of antenatal steroids).…”

Individual and Center-Level Factors Affecting Mortality Among Extremely Low Birth Weight Infants

“…17 More active intervention of extremely preterm infants may benefit not only these infants but also more mature infants; centers in which intensive care is more frequently provided to extremely preterm infants have been shown to have better outcomes, too, for preterm infants of later gestation. 18 Neonatal care has been advanced by the development and testing of beneficial therapies. 19 It is important to note that the magnitude of the center effect on ELBW mortality is larger than the intervention effects of even the most potent therapies, such as antenatal corticosteroids and surfactant replacement therapy.…”

Changes in the outcome of extremely low birth weight infants less than 500 grams in the First Department of Obstetrics and Gynecology, Semmelweis University

“…Rég-óta ismert, hogy a chorioamnionitis a magzati szövetek-ben gyulladásos reakciót indít el, amely enyhe esetekben a surfactanttermelés stimulusa lehet, míg a súlyos esetek az alveolocapillaris egység károsodását okozhatja, követ-kezményes surfactantinaktiválódással. Ilyen esetekben hatástalannak tűnik a surfactantpótló kezelés, csak nagyobb, illetve ismételt dózis adása után lesz sikeres [13]. A koraszülés oka az esetek 60-70%-ában fertőzés, más esetekben összetett az etiológia, és az okok között a fertőzés is szerepel [14].…”