Changes in Mortality for Extremely Low Birth Weight Infants in the 1990s: Implications for Treatment Decisions and Resource Use

Meadow, William; Lee, Grace; Lin, Kathy; Lantos, John D.

doi:10.1542/peds.113.5.1223

Cited by 124 publications

(99 citation statements)

References 23 publications

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“…As reported in other studies, 2,27,28 better survival was associated with increased age at death. Although some infants died later in high-activity regions, in most cases the increased age at death (median: 2.5 days) allowed for a trial of life.…”

Section: Discussionsupporting

confidence: 84%

“…There are concerns that intensive care is imposed on infants who ultimately die, 27 and the time to death for these infants has indeed increased. 2,27,28 The EPT Infants in Sweden Study (EXPRESS study) 29 includes all infants born at a gestational age ,27 weeks during 2004-2007 and reported increased 1-year survival compared with other published studies. Despite a generally proactive management strategy, subsequent analysis revealed differences in perinatal activity and in 1-year mortality between Swedish health care regions.…”

Section: What This Study Addsmentioning

confidence: 99%

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Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years

et al. 2015

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, for the EXPRESS Study Group abstract OBJECTIVE: To examine the association between intensity of perinatal care and outcome at 2.5 years' corrected age (CA) in extremely preterm (EPT) infants (,27 weeks) born in Sweden during 2004-2007. METHODS: A national prospective study in 844 fetuses who were alive at the mother's admission for delivery: 707 were live born, 137 were stillborn. Infants were assigned a perinatal activity score on the basis of the intensity of care (rates of key perinatal interventions) in the infant's region of birth. Scores were calculated separately for each gestational week (gestational age [GA]-specific scores) and for the aggregated cohort (aggregated activity scores). Primary outcomes were 1-year mortality and death or neurodevelopmental disability (NDI) at 2.5 years' CA in fetuses who were alive at the mother's admission. In health care regions with higher aggregated activity scores, the risk of death or NDI at 2.5 years' CA was reduced in the primary population (aOR: 0.69; 95% CI: 0.50-0.96) and in live-born infants (aOR: 0.68; 95% CI: 0.48-0.95). Risk reductions were confined to the 22-to 24-week group. There was no difference in NDI risk between survivors at 2.5 years' CA.CONCLUSIONS: Proactive perinatal care decreased mortality without increasing the risk of NDI at 2.5 years' CA in EPT infants. A proactive approach based on optimistic expectations of a favorable outcome is justified.

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Section: Discussionsupporting

confidence: 84%

Section: What This Study Addsmentioning

confidence: 99%

Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years

et al. 2015

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“…1 Five minutes after birth, prediction of death can be improved by adding the Apgar score, which reflects the early care and infant response. 2 Because the risk of mortality is lower if initial resuscitation is successful, and declines over the first few weeks, 3 a prediction made at the time of birth for subsequent death/NDI is an overestimate for mortality if the infant survives beyond this vulnerable period. Conversely, in an infant predicted to have a good outcome at birth, complications such as bronchopulmonary dysplasia or retinopathy of prematurity substantially reduce the probability of a good outcome.…”

Section: Resultsmentioning

confidence: 99%

Outcome Trajectories in Extremely Preterm Infants

et al. 2012

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WHAT'S KNOWN ON THIS SUBJECT: Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth by considering gender, antenatal steroids, multiple birth, birth weight, and gestational age.WHAT THIS STUDY ADDS: Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas that of respiratory illness severity increases with advancing postnatal age. abstract OBJECTIVE: Methods are required to predict prognosis with changes in clinical course. Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth/admission to the ICU by considering gender, antenatal steroids, multiple birth, birth weight, and gestational age. Predictions may be improved by using additional information available later during the clinical course. Our objective was to develop serial predictions of outcome by using prognostic factors available over the course of NICU hospitalization.METHODS: Data on infants with birth weight #1.0 kg admitted to 18 large academic tertiary NICUs during 1998-2005 were used to develop multivariable regression models following stepwise variable selection. Models were developed by using all survivors at specific times during hospitalization (in delivery room [n = 8713], 7-day [n = 6996], 28-day [n = 6241], and 36-week postmenstrual age [n = 5118]) to predict death or death/neurodevelopmental impairment at 18 to 22 months. RESULTS:Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas the importance of respiratory illness severity increases with advancing postnatal age. The c-statistic in validation models ranged from 0.74 to 0.80 with misclassification rates ranging from 0.28 to 0.30.CONCLUSIONS: Dynamic models of the changing probability of individual outcome can improve outcome predictions in preterm infants. Various current and future scenarios can be modeled by input of different clinical possibilities to develop individual "outcome trajectories" and evaluate impact of possible morbidities on outcome. Pediatrics 2012;130:e115-e125 AUTHORS:

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“…Houve concentração de ocorrência de óbitos até o quarto dia de vida; posteriormente observou-se um lento declínio, padrão semelhante ao encontrado em países desenvolvidos 9,23 .…”

Section: Introductionunclassified

Sobrevida e fatores de risco para mortalidade neonatal em uma coorte de nascidos vivos de muito baixo peso ao nascer, na Região Sul do Município de São Paulo, Brasil

et al. 2011

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Estudos populacionais sobre mortalidade neonatal de nascimentos de muito baixo peso ao nascer contribuem para identificar sua complexa rede de fatores de risco. Foi estudada uma coorte de 213 recém-nascidos com peso inferior a 1.500g (112 óbitos neonatais e 101 sobreviventes) na Região Sul do Município de São Paulo, Brasil, em 2000/2001. Foram realizadas entrevistas domiciliares e obtidos dados de prontuários hospitalares. Foi realizada análise de sobrevida e empregada regressão múltipla de Cox. A elevada mortalidade na sala de parto, no primeiro dia de vida e ausência de sobreviventes < 700g dos nascimentos < 1.000g e com menos de 28 semanas sugere que condutas mais ativas destinam-se a nascituros de maior viabilidade. Mães residentes em favela, com história anterior de cesárea e aborto provocado, adolescentes, com sangramento vaginal e ausência de pré-natal aumentaram o risco de óbito neonatal. Partos cesarianos e internação em berçários mostraram efeito protetor. O peso ao nascer abaixo de 1.000g e Apgar menor que 7 foram risco. A elevada mortalidade está associada às condições de vida, características maternas e dos nascimentos e condições assistenciais. A melhoria da atenção pré-natal e ao recém-nascido pode atuar na redução da mortalidade.

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Changes in Mortality for Extremely Low Birth Weight Infants in the 1990s: Implications for Treatment Decisions and Resource Use

Cited by 124 publications

References 23 publications

Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years

Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years

Outcome Trajectories in Extremely Preterm Infants

Sobrevida e fatores de risco para mortalidade neonatal em uma coorte de nascidos vivos de muito baixo peso ao nascer, na Região Sul do Município de São Paulo, Brasil

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