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Survival rates increase for extremely preterm infants over 20-year period
Survival rates, along with other notable changes in preterm care, improved for most preterm infants during a 20-year span, a recent study reported.
“This study of extremely preterm infants born at [Neonatal Research Network (NRN)] centers is the first comprehensive review to our knowledge to evaluate how care practices, major morbidities, and mortality have evolved,” Barbara J. Stoll, MD, of the department of pediatrics at Emory University School of Medicine, and colleagues wrote. “We demonstrated a significant increase in survival to discharge for infants born at 23, 24, 25 and 27 weeks, with the largest gains for those born at 23 and 24 weeks.”
The researchers compiled data from 26 NRN centers on 34,636 very low birth weight infants (401 g to 1,500 g) born between 22 and 28 gestational weeks during the period from 1993 to 2012. Factors associated with change in maternal neonatal care, including maternal age, race/ethnicity, prenatal care, multiple births, and birth defects, were analyzed. Care practices such as whether antenatal corticosteroids were given, resuscitation was performed at delivery and caesarean delivery occurred also were reviewed.
Study results showed increased survival for infants born at gestational week 23, from 27% in 2009 to 33% in 2012 (adjusted RR = 1.09; 95% CI, 1.05-1.14). Similarly, survival increased for infants born at week 24, from 63% to 65% (aRR = 1.05; 95% CI, 1.03-1.07). Survival for infants born at weeks 25 and 27 followed this same trend, with smaller increases. Infants born at weeks 22, 26 and 28 had no statistically significant change in mortality.
Infants born at gestational weeks 25 to 28 had a 2% annual increase in survival without major morbidity during the study period. Infants born at weeks 22 to 24, however, had no significant change in survival without major morbidity.
Stoll and colleagues also noted:
- antenatal corticosteroid use increased from 24% to 84% from 1993 to 2012;
- delivery by caesarean section grew from 44% for preterm births to 64% during the same period; and
- bronchopulmonary dysplasia increased from 50% to 55% from 2009 to 2012, while other morbidities declined.
“Although survival of extremely preterm infants has increased over the past 2 decades, including survival without major morbidity, the individual and societal burden of preterm birth remains substantial, with approximately 450,000 neonates born prematurely in the United States each year,” Stoll and colleagues wrote. “To truly affect newborn outcomes, a comprehensive and sustained effort to reduce the high rates of preterm birth is necessary.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
