Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g

Abstract

IMPORTANCE 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. OBJECTIVE To characterize outcomes of liveborn infants with a BW less than 400 g. DESIGN, SETTING, AND PARTICIPANTS 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. EXPOSURES Birth weight less than 400 g. MAIN OUTCOMES AND MEASURES 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. RESULTS 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%). CONCLUSIONS AND RELEVANCE 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.

Atraso Do Desenvolvimento Neuropsicomotor Entre Recém-Nascidos De Alto Risco Acompanhados Em Um Ambulatório De Seguimento

“…O acompanhados em ambulatório de seguimento, ao longo do primeiro ano de vida tem como premissa o acompanhamento de recém-nascidos de alto risco, sendo a maior parte deles prematuros. Esse grupo se caracteriza por um elevado risco de comprometimento do DNPM, nos primeiros anos de vida (2)(3)(4) .…”

“…Os avanços tecnológicos e a melhoria dos cuidados implementados para assistência imediata ao recém-nascido, tanto nas salas de parto como nas Unidades de Terapia Intensiva Neonatal (UTIN) têm auxiliado na redução das taxas de mortalidade e propiciado a sobrevida de crianças cada vez mais prematuras (1,2) . Todavia, a sobrevida para muitas crianças não implica em qualidade de vida, e se associa a um elevado número de sequelas (3,4) .…”

Producing valid statistics when legislation, culture and medical practices differ for births at or before the threshold of survival: report of a European workshop

“…However, this strategy excludes a significant number of stillbirths, at least one in five deaths before 24 weeks of gestation and over one in three deaths before 28 weeks . As the gestational age limit for initiation of neonatal care decreases, exclusion of these stillbirths limits the full evaluation of care provision and outcomes at early gestational ages. Further, it underestimates the burden of loss on parents’ mental and physical health …”

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

“…The care of periviable infants presents substantial challenges in neonatal and perinatal medicine [1,2]. Recent studies report survival of infants born at 22 weeks of gestation, leading to increased active resuscitation at this gestational age (GA) [3,4]. The survival of infants born at 22-24 weeks GA varies greatly based on GA and hospital of birth [5][6][7].…”