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Outcomes for extremely premature infants
#MMPMID25988638
Glass HC
; Costarino AT
; Stayer SA
; Brett CM
; Cladis F
; Davis PJ
Anesth Analg
2015[Jun]; 120
(6
): 1337-51
PMID25988638
show ga
Premature birth is a significant cause of infant and child morbidity and
mortality. In the United States, the premature birth rate, which had steadily
increased during the 1990s and early 2000s, has decreased annually for 7 years
and is now approximately 11.39%. Human viability, defined as gestational age at
which the chance of survival is 50%, is currently approximately 23 to 24 weeks in
developed countries. Infant girls, on average, have better outcomes than infant
boys. A relatively uncomplicated course in the intensive care nursery for an
extremely premature infant results in a discharge date close to the prenatal
estimated date of confinement. Despite technological advances and efforts of
child health experts during the last generation, the extremely premature infant
(less than 28 weeks gestation) and extremely low birth weight infant (<1000 g)
remain at high risk for death and disability with 30% to 50% mortality and, in
survivors, at least 20% to 50% risk of morbidity. The introduction of continuous
positive airway pressure, mechanical ventilation, and exogenous surfactant
increased survival and spurred the development of neonatal intensive care in the
1970s through the early 1990s. Routine administration of antenatal steroids
during premature labor improved neonatal mortality and morbidity in the late
1990s. The recognition that chronic postnatal administration of steroids to
infants should be avoided may have improved outcomes in the early 2000s. Evidence
from recent trials attempting to define the appropriate target for oxygen
saturation in preterm infants suggests arterial oxygen saturation between 91% and
95% (compared with 85%-89%) avoids excess mortality; however, final analyses of
data from these trials have not been published, so definitive recommendations are
still pending. The development of neonatal neurocritical intensive care units may
improve neurocognitive outcomes in this high-risk group. Long-term follow-up to
detect and address developmental, learning, behavioral, and social problems is
critical for children born at these early gestational ages.The striking
similarities in response to extreme prematurity in the lung and brain imply that
agents and techniques that benefit one organ are likely to also benefit the
other. Finally, because therapy and supportive care continue to change, the
outcomes of extremely low birth weight infants are ever evolving. Efforts to
minimize injury, preserve growth, and identify interventions focused on
antioxidant and anti-inflammatory pathways are now being evaluated. Thus,
treating and preventing long-term deficits must be developed in the context of a
"moving target."
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