Authors

Edward F. Bell, Department of Pediatrics, University of Iowa, Iowa City
Susan R. Hintz, Department of Pediatrics, Stanford University, Palo Alto, California
Nellie I. Hansen, Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
Carla M. Bann, Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
Myra H. Wyckoff, Department of Pediatrics, University of Texas Southwestern, Dallas
Sara B. DeMauro, Department of Pediatrics, University of Pennsylvania, Philadelphia
Michele C. Walsh, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
Betty R. Vohr, Department of Pediatrics, Brown University, Providence, Rhode Island
Barbara J. Stoll, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
Waldemar A. Carlo, Department of Pediatrics, University of Alabama, Birmingham
Krisa P. Van Meurs, Department of Pediatrics, Stanford University, Palo Alto, California
Matthew A. Rysavy, Department of Pediatrics, University of Texas at Houston, Houston
Ravi M. Patel, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
Stephanie L. Merhar, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
Pablo J. Sánchez, Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus
Abbot R. Laptook, Department of Pediatrics, Brown University, Providence, Rhode Island
Anna Maria Hibbs, Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio
C Michael Cotten, Department of Pediatrics, Duke University, Durham, North Carolina
Carl T. D'Angio, Department of Pediatrics, University of Rochester, Rochester, New York
Sarah Winter, Department of Pediatrics, University of Utah, Salt Lake City
Janell Fuller, Department of Pediatrics, University of New Mexico, Albuquerque
Abhik Das, Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

Document Type

Article

Publication Date

1-18-2022

Abstract

IMPORTANCE: Despite improvement during recent decades, extremely preterm infants continue to contribute disproportionately to neonatal mortality and childhood morbidity.

OBJECTIVE: To review survival, in-hospital morbidities, care practices, and neurodevelopmental and functional outcomes at 22-26 months' corrected age for extremely preterm infants.

DESIGN, SETTING, AND PARTICIPANTS: Prospective registry for extremely preterm infants born at 19 US academic centers that are part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. The study included 10 877 infants born at 22-28 weeks' gestational age between January 1, 2013, and December 31, 2018, including 2566 infants born before 27 weeks between January 1, 2013, and December 31, 2016, who completed follow-up assessments at 22-26 months' corrected age. The last assessment was completed on August 13, 2019. Outcomes were compared with a similar cohort of infants born in 2008-2012 adjusting for gestational age.

EXPOSURES: Extremely preterm birth.

MAIN OUTCOMES AND MEASURES: Survival and 12 in-hospital morbidities were assessed, including necrotizing enterocolitis, infection, intracranial hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia. Infants were assessed at 22-26 months' corrected age for 12 health and functional outcomes, including neurodevelopment, cerebral palsy, vision, hearing, rehospitalizations, and need for assistive devices.

RESULTS: The 10 877 infants were 49.0% female and 51.0% male; 78.3% (8495/10848) survived to discharge, an increase from 76.0% in 2008-2012 (adjusted difference, 2.0%; 95% CI, 1.0%-2.9%). Survival to discharge was 10.9% (60/549) for live-born infants at 22 weeks and 94.0% (2267/2412) at 28 weeks. Survival among actively treated infants was 30.0% (60/200) at 22 weeks and 55.8% (535/958) at 23 weeks. All in-hospital morbidities were more likely among infants born at earlier gestational ages. Overall, 8.9% (890/9956) of infants had necrotizing enterocolitis, 2.4% (238/9957) had early-onset infection, 19.9% (1911/9610) had late-onset infection, 14.3% (1386/9705) had severe intracranial hemorrhage, 12.8% (1099/8585) had severe retinopathy of prematurity, and 8.0% (666/8305) had severe bronchopulmonary dysplasia. Among 2930 surviving infants with gestational ages of 22-26 weeks eligible for follow-up, 2566 (87.6%) were examined. By 2-year follow-up, 8.4% (214/2555) of children had moderate to severe cerebral palsy, 1.5% (38/2555) had bilateral blindness, 2.5% (64/2527) required hearing aids or cochlear implants, 49.9% (1277/2561) had been rehospitalized, and 15.4% (393/2560) required mobility aids or other supportive devices. Among 2458 fully evaluated infants, 48.7% (1198/2458) had no or mild neurodevelopmental impairment at follow-up, 29.3% (709/2419) had moderate neurodevelopmental impairment, and 21.2% (512/2419) had severe neurodevelopmental impairment.

CONCLUSIONS AND RELEVANCE: Among extremely preterm infants born in 2013-2018 and treated at 19 US academic medical centers, 78.3% survived to discharge, a significantly higher rate than for infants born in 2008-2012. Among infants born at less than 27 weeks' gestational age, rehospitalization and neurodevelopmental impairment were common at 2 years of age.

Publisher

American Medical Association

Publication Title

JAMA : the journal of the American Medical Association

ISSN

1538-3598

Volume

327

Issue

3

First Page

248

Last Page

263

DOI

10.1001/jama.2021.23580

Share

COinS