Outcomes for Extremely Premature Infants

Abstract

Premature birth is a significant cause of infant and child morbidity and mortality. In the United States, the premature birth rate, which had steadily increased during the 1990s and early 2000s, has decreased annually for four years and is now approximately 11.5%. Human viability, defined as gestational age at which the chance of survival is 50%, is currently approximately 23–24 weeks in developed countries. Infant girls, on average, have better outcomes than infant boys. A relatively uncomplicated course in the intensive care nursery for an extremely premature infant results in a discharge date close to the prenatal EDC. Despite technological advances and efforts of child health experts during the last generation, the extremely premature infant (less than 28 weeks gestation) and extremely low birth weight infant (ELBW) (< 1000 grams) remain at high risk for death and disability with 30–50% mortality and, in survivors, at least 20–50% risk of morbidity. The introduction of CPAP, mechanical ventilation, and exogenous surfactant increased survival and spurred the development of neonatal intensive care in the 1970s through the early 1990s. Routine administration of antenatal steroids during premature labor improved neonatal mortality and morbidity in the late 1990s. The recognition that chronic postnatal administration of steroids to infants should be avoided may have improved outcomes in the early 2000s. Evidence from recent trials attempting to define the appropriate target for oxygen saturation in preterm infants suggests arterial oxygen saturation between 91–95% (compared to 85–89%) avoids excess mortality. However, final analyses of data from these trials have not been published, so definitive recommendations are still pending The development of neonatal neurocognitive care visits may improve neurocognitive outcomes in this high-risk group. Long-term follow up to detect and address developmental, learning, behavioral, and social problems is critical for children born at these early gestational ages. The striking similarities in response to extreme prematurity in the lung and brain imply that agents and techniques that benefit one organ are likely to also benefit the other. Finally, since therapy and supportive care continue to change, the outcomes of ELBW infants are ever evolving. Efforts to minimize injury, preserve growth, and identify interventions focused on antioxidant and anti-inflammatory pathways are now being evaluated. Thus, treating and preventing long-term deficits must be developed in the context of a “moving target.”

Trends in Overall Mortality, and Timing and Cause of Death among Extremely Preterm Infants near the Limit of Viability

“…Nonetheless, EPT infants remain at the highest risk of neonatal and infant mortality worldwide [8,9]. Active treatment in infants born at or less than 24 weeks’ gestation varies widely between hospitals; in turn, there are broad inter-center differences in the survival of these infants [10].…”

Ethical issues in NICUs: The Attitude of Greek Healthcare Professionals Towards the Value of Human Life

“…The birth of extremely/very preterm babies or babies with extremely low/very low birth weight continues to be a discouraging epidemiological reality with minimal (if any) important improvements in survival rates and rates of neurological and developmental problems incurring after hospital release [1][2][3][4][5][6]. This epidemiological reality however, raises serious bioethical questions for healthcare professionals responsible for the provision of neonatal intensive care [7,8].…”

Mild intrauterine hypoperfusion reproduces neurodevelopmental disorders observed in prematurity

“…Mild brain injuries include decreased white matter volume and cortical thickness with no obvious periventricular leukomalacia (PVL) or focal lesions. Infants with mild brain injuries frequently present with mild neurodevelopmental disorders (NDDs), such as attention-deficit/hyperactivity disorder (ADHD) and borderline intellectual functioning4. Mild NDDs associated with prematurity and IUGR have been increasing, and this phenomenon is now recognized as a critical social issue in developed countries; approximately 20% of very LBW (<1500 g) infants and 50% of extremely LBW (<1000 g) infants exhibit mild NDDs567.…”