April 10, 2019
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Active treatment improves survival in smallest US babies

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Photo of Jane Brumbaugh
Jane E. Brumbaugh

About 13% of infants survive to discharge when they are born weighing less than 400 g — or slightly less than 1 pound — and those who do survive face an increased risk for neurodevelopmental impairment. However, researchers said active treatment considerably improves the infants’ chances of survival.

Perspective from Erin Osterholm, MD

According to Jane E. Brumbaugh, MD, assistant professor of neonatal medicine at the Mayo Clinic, and colleagues from the National Institute of Child Health and Human Development Neonatal Research Network, it was assumed in the 1980s that infants born weighing less than 500 g had a mortality rate of approximately 100%. The researchers wrote that this is no longer the case because of increased use of available treatments, including intubation, surfactant therapy, respiratory support, chest compressions, epinephrine, volume resuscitation, blood pressure support and parenteral nutrition.

They added that although some studies on the outcomes of low-birth-weight infants have included children weighing less than 400 g at birth, few details are available on this specific group.

The researchers conducted a retrospective multicenter cohort study that included 205 infants in this weight range who were born between 22 to 26 weeks’ gestational age. All infants were born between January 2008 and December 2016.

Baby in the NICU 
Source: Adobe

More than half of the infants (64.9%) were singletons, and nearly all (86.8%) were born small for gestational age. Active treatment, or any potentially lifesaving intervention, was used for 49.3% of infants at birth.

Brumbaugh said the reasons why about half of the infants in the study were not given active treatment at birth were not assessed, but she speculated that parents and physicians had decided that no active efforts at resuscitation would be made because the chance of survival was extremely low.

The researchers said that 26 infants (12.7%; 95% CI, 8.5-18.9) survived to discharge. However, infants who received active treatment were more likely to survive to discharge (25.7%; 95% CI, 17.6-35.4).

When Brumbaugh and colleagues examined the outcomes of infants born at 22 to 23 weeks’ gestational age and weighing less than 400 g, the found that 17% (95% CI, 6-33; n = 6) survived to discharge after receiving active treatment.

Out of the 90 actively treated infants, 19 (21%; 95% CI, 13-31) were known to have survived at 18 to 26 months’ corrected age. Nearly three-quarters (74%; n = 14) of these infants had moderate to severe neurodevelopmental impairment.

The findings of improved survival following active treatment among infants born weighing less than 400 g suggest that informed conversations about goals of care are warranted, according to the researchers.

“We encourage centers to track the outcomes of their smallest infants and to be cognizant of the possibility of survival when counseling families,” Brumbaugh told Infectious Diseases in Children. “Even infants born weighing less than 400 g have a chance to live if provided active treatment at birth. Children that survive can have a meaningful life. A few appear to be free of any significant delays at age 2 years.”– by Katherine Bortz

Disclosures: Brumbaugh reports no relevant financial disclosures. Please see the study for a list of all other authors’ relevant financial disclosures.