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

American Academy of Pediatrics (AAP) - Tập 126 Số 3 - Trang 443-456 - 2010
Barbara J. Stoll1, Nellie I. Hansen2, Edward F. Bell3, Seetha Shankaran4, Abbot R. Laptook5, Michele C. Walsh6, Ellen C. Hale1, Nehal A. Parikh6, Kurt Schibler7, Waldemar A. Carlo8, Kathleen A. Kennedy9, Brenda B. Poindexter10, Neil N. Finer11, Richard A. Ehrenkranz12, Shahnaz Duara13, Pablo J. Sánchez14, T. Michael O’Shea15, Krisa P. Van Meurs16, Roger G. Faix17, Dale L. Phelps18, Ivan D. Frantz19, Kristi L. Watterberg20, Somnath Saha2, Abhik Das21, Rosemary D. Higgins22
1Department of Pediatrics, School of Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia;
2Statistics and Epidemiology Unit, RTI International, Research Triangle Park, North Carolina;
3Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa
4Department of Pediatrics, School of Medicine, Wayne State University, Detroit, Michigan
5Department of Pediatrics, Women and Infants Hospital, Brown University, Providence, Rhode Island
6Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University, Cleveland, Ohio
7Department of Pediatrics, School of Medicine, University of Cincinnati, Cincinnati, Ohio;
8Division of Neonatology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama;
9Department of Pediatrics, University of Texas Medical School at Houston, Houston, Texas
10Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana
11Department of Neonatology, University of California, San Diego, Medical Center, San Diego, California;
12Department of Pediatrics, School of Medicine, Yale University, New Haven, Connecticut
13Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida
14Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
15Department of Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
16Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California;
17Division of Neonatology, Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah;
18Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York;
19Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, Massachusetts;
20Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
21Statistics and Epidemiology Unit, RTI International, Rockville, Maryland; and
22Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland

Tóm tắt

OBJECTIVE:

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).

METHODS:

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.

RESULTS:

Rates of survival to discharge increased with increasing GA (6% at 22 weeks and 92% at 28 weeks); 1060 infants died at ≤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.

CONCLUSION:

Although the majority of infants with GAs of ≥24 weeks survive, high rates of morbidity among survivors continue to be observed.

Từ khóa


Tài liệu tham khảo

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American Academy of Pediatrics (AAP)

Tập 126 Số 3

443-456

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