Medications and in-hospital outcomes in infants born at 22–24 weeks of gestation

Puia‐Dumitrescu, Mihai; Younge, Noelle; Benjamin, Daniel K.; Lawson, Katie M.; Hume, Cordelia; Hill, Kennedy; Mengistu, Jonathan; Wilson, Aryeona; Zimmerman, Kanecia O.; Ahmad, Kaashif A.; Greenberg, Rachel G.

doi:10.1038/s41372-020-0614-4

Cited by 17 publications

(16 citation statements)

References 52 publications

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“…The survival rate of periviable infants varies greatly between studies and countries [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Although the related ethics issues are under debate, aggressive treatments improve the survival rate of periviable infants, especially those born at 22–23 weeks GA [ 7 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Periviable birth is defined as delivery happening from 20 0/7 to 25 6/7 weeks gestational age (wGA) [ 4 , 5 , 6 ]. In the past two decades, there have been reports of increased rates of survival of periviable infants born at 22–25 wGA from single centers or large cohorts in Taiwan, Japan, USA, France, Germany, and Australia [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. However, the reported survival rate of periviable infants varied between reports (49.7–86.2%) [ 9 , 11 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Improved Survival of Periviable Infants after Alteration of the Threshold of Viability by the Neonatal Resuscitation Program 2015

Chen

et al. 2021

Children

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Periviable infants (PIs) born at 22–25 weeks gestational age (wGA) have a variable survival rate (49.7–86.2%) among hospitals. One factor involved in this difference may be the definition of the threshold of viability. The American Academy of Pediatrics revised the neonatal resuscitation program in late 2015 (NRP 2015) and altered the threshold of viability from 23 to 22 wGA. The impact on the survival of PIs after the guideline alteration has seldom been discussed. Since 2016, the unit of this study has implemented the renewed guideline for PIs. We retrospectively reviewed and analyzed the survival and clinical variables of PIs before and after implementation of the guideline, which included a 10-year cohort in a single center in Taiwan. There were 168 PIs enrolled between 2010 and 2019 (Epoch-I, 2010–2015; Epoch-II, 2016–2019), after excluding those with congenital anomalies and parent-decided comfort care. Compared to those in Epoch-I, the PIs in Epoch-II had significantly higher odds ratios (2.602) (95% confidence interval: 1.170–5.789; p = 0.019) for survival. Younger gestational age, small size for gestational age, cesarean delivery, low blood pH at birth, and surfactant therapeutic treatment were found to be significant risk factors associated with the survival of PIs (p < 0.05 for each). The altered threshold of viability by NRP 2015 may impact the survival of PIs. However, long-term follow-up for surviving PI is required in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improved Survival of Periviable Infants after Alteration of the Threshold of Viability by the Neonatal Resuscitation Program 2015

Chen

et al. 2021

Children

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“…Thirty-four of 60 studies reported the proportion of preterm infants (born at <37 weeks gestational age) among their cohort (range 20% [24] to 87% [71]) in addition to the two studies (34), (31) that included preterm infants only. In addition, one study Puia-Dumitrescu 2020 [72] reported drugs received by infants born at 22-24 weeks gestational age only.…”

Section: Number Of Drugs Per Infantmentioning

confidence: 99%

“…North America (10 studies) [8,9,28,38,53,60,69,70,72,78] ampicillin (8 studies), gentamicin (8 studies), furosemide (6 studies), surfactant (6 studies), penicillin (5 studies), vancomycin (6 studies), caffeine citrate* (6 studies), cefotaxime (4 studies), dopamine (5 studies), calcium gluconate (4 studies) Asia (6 studies) [14,17,19,51,55,73] phenobarbitone (4 studies), vitamin K (4 studies), amikacin (3 studies), aminophylline (3 studies), ceftriaxone (2 studies), ceftazidime (2 studies), gentamicin (2 studies), phenytoin (2 studies), penicillin/sulbactam (2 studies),caffeine (1 study) Latin America and Caribbean (4 studies) [15,24,32,41] fentanyl (4 studies), gentamicin (3 studies), vancomycin (3 studies), multivitamins (3 studies), amikacin (2 studies), ampicillin (2 studies), furosemide (2 studies), aminophylline (2 studies), morphine (1 study), metamizole (1 study)…”

Section: Geographic Region (Number Of Studies) (Ref) Most Frequently mentioning

confidence: 99%

Review of Drug Utilization Studies in Neonatal Units: A Global Perspective

Al-Turkait

Szatkowski

Choonara

et al. 2020

IJERPH

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Rational prescribing is challenging in neonatology. Drug utilization studies help identify and define the problem. We performed a review of the literature on drug use in neonatal units and describe global variations. We searched databases (EMBASE, CINAHL and Medline) from inception to July 2020, screened studies and extracted relevant data (two reviewers). The search revealed 573 studies of which 84 were included. India (n = 14) and the USA (n = 13) reported the most. Data collection was prospective (n = 56) and retrospective (n = 26), mostly (n = 52) from one center only. Sixty studies described general drug use in 34 to 450,386 infants (median (IQR) 190 (91–767)) over a median (IQR) of 6 (3–18) months. Of the participants, 20–87% were preterm. The mean number of drugs per infant (range 11.1 to 1.7, pooled mean (SD) 4 (2.4)) was high with some reporting very high burden (≥30 drugs per infant in 8 studies). This was not associated with the proportion of preterm infants included. Antibiotics were the most frequently used drug. Drug use patterns were generally uniform with some variation in antibiotic use and more use of phenobarbitone in Asia. This study provides a global perspective on drug utilization in neonates and highlights the need for better quality information to assess rational prescribing.

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“…The U.S. FDA experience with drug development in neonates is minimal; of 301 pediatric drug development programs reviewed in 2015, only 26 included neonatal labeling, and only 8 drugs had studies that contained sufficient neonate data to support population PK (POPPK) analysis in this age group 4 . In 2021, clinical trial networks like the Pediatric Trials Network continue to make progress in informing pediatric labeling for the understudied neonatal populations 5–11 …”

mentioning

confidence: 99%