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Periviable infants more likely to survive without neurodevelopmental impairment
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A recent study shows that infants born between 22 and 24 weeks of gestation now have a higher survival rate and less chance of neurodevelopmental impairment.
“[Neonatal Research Network (NRN)] studies over previous periods have not shown significant improvement in neurodevelopmental outcomes over time among periviable infants, and there is concern that declining mortality in this population may lead to a greater number of infants surviving with neurodevelopmental impairment,” Noelle Younge, MD, MHS, a neonatologist from Duke University, and colleagues wrote. “The availability of data on both mortality and neurodevelopmental outcomes among survivors is important for families and clinicians making early care decisions for these high-risk infants.”
To determine how neurodevelopmental impairment rates connected with current periviable birth, the researchers compared survival rates and neurodevelopmental outcomes of children born in 11 centers that participated in the National Institute of Child Health and Human Development Neonatal Research Network. These infants were born between 22 and 24 weeks of gestation, and were assessed at 18 to 22 months of adjusted age.
Infants were measured according to a three-level outcome: survival without neurodevelopmental impairment, survival with neurodevelopmental impairment or death. Multinomial generalized logit models were used to compare the relative placement within the three outcomes for participants. Researchers accounted for differences in several characteristics, including birth center, and infants were separated into three birth-year epochs, including 2000-2003 (1), 2004-2007 (2) and 2008-2011 (3).
When comparing epoch 1 with epoch 3, researchers found that the survival rate increased from 30% in epoch 1 to 36% in epoch 3. An increase from 16% to 20% was also seen in the number of infants who survived without neurodevelopmental impairment.
A statistical model was used to adjust for baseline characteristics that may have changed over time, and the three outcomes were compared against each other. According to Younge, both survival with and without neurodevelopmental impairment increased compared with death.
“The direction of the result indicates that survival without impairment increased at a rate greater than or similar to survival with impairment,” she wrote, adding that the 23-week infant subgroup’s chance of survival without impairment was significantly greater than survival with impairment.
“Prognosis continues to be guarded; in the most recent epoch, mortality was 64%, and 43% of surviving infants had neurodevelopmental impairment,” Younge and colleagues wrote. “The improvements in survival and neurodevelopmental outcomes that we observed may reflect advances in obstetrical and neonatal care.” – by Katherine Bortz
Disclosure: Dr. Patel reports receiving an honorarium from Pediatrix Medical Group, a unit of MEDNAX. Dr. Cotten reports receiving fees for serving on a data and safety monitoring board from rEVO Biologics. No other potential conflict of interest relevant to this article was reported.
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