Neonatal Outcomes of Extremely Preterm Infants From the NICHD Neonatal Research Network

TLDR

This study reports NICHD Neonatal Research Network data on care, morbidity, and mortality of very low birth weight infants by gestational age. The study analyzed perinatal and neonatal data from 9,575 infants born at 22–28 weeks gestation and weighing 401–1,500 g, collected across network centers from 2003 to 2007. Survival to discharge increased from 6% at 22 weeks to 92% at 28 weeks, yet early deaths were common at the lowest gestations, and morbidities were frequent—93% had respiratory distress syndrome, 46% patent ductus arteriosus, 16% severe intraventricular hemorrhage, 11% necrotizing enterocolitis, and 36% late‑onset sepsis—with more than half of extremely low‑GA infants having undetermined retinopathy status and significant center‑level variation in outcomes.

Abstract

This report presents data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network on care of and morbidity and mortality rates for very low birth weight infants, according to gestational age (GA). Perinatal/neonatal data were collected for 9575 infants of extremely low GA (22-28 weeks) and very low birth weight (401-1500 g) who were born at network centers between January 1, 2003, and December 31, 2007. Rates of survival to discharge increased with increasing GA (6% at 22 weeks and 92% at 28 weeks); 1060 infants died at <or=12 hours, with most early deaths occurring at 22 and 23 weeks (85% and 43%, respectively). Rates of prenatal steroid use (13% and 53%, respectively), cesarean section (7% and 24%, respectively), and delivery room intubation (19% and 68%, respectively) increased markedly between 22 and 23 weeks. Infants at the lowest GAs were at greatest risk for morbidities. Overall, 93% had respiratory distress syndrome, 46% patent ductus arteriosus, 16% severe intraventricular hemorrhage, 11% necrotizing enterocolitis, and 36% late-onset sepsis. The new severity-based definition of bronchopulmonary dysplasia classified more infants as having bronchopulmonary dysplasia than did the traditional definition of supplemental oxygen use at 36 weeks (68%, compared with 42%). More than one-half of infants with extremely low GAs had undetermined retinopathy status at the time of discharge. Center differences in management and outcomes were identified. Although the majority of infants with GAs of >or=24 weeks survive, high rates of morbidity among survivors continue to be observed.