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Deprecated: Implicit conversion from float 227.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 JAMA 2015 ; 314 (10): 1039-51 Nephropedia Template TP
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Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993?2012 #MMPMID26348753
Stoll BJ; Hansen NI; Bell EF; Walsh MC; Carlo WA; Shankaran S; Laptook AR; Sánchez PJ; Van Meurs KP; Wyckoff M; Das A; Hale EC; Ball MB; Newman NS; Schibler K; Poindexter BB; Kennedy KA; Cotten CM; Watterberg KL; D?Angio CT; DeMauro SB; Truog WE; Devaskar U; Higgins RD
JAMA 2015[Sep]; 314 (10): 1039-51 PMID26348753show ga
Importance: Extremely preterm infants contribute disproportionately to neonatal morbidity and mortality. Objective: To review 20-year trends in maternal/neonatal care, complications, and mortality among extremely preterm infants born at Neonatal Research Network centers. Design, Setting, Participants: Prospective registry of 34,636 infants 22?28 weeks? gestational age (GA) and 401?1500 gram birthweight born at 26 Network centers, 1993?2012. Exposure: Extremely preterm birth. Main Outcomes: Maternal/neonatal care, morbidities, and survival. Major morbidities, reported for infants who survived more than 12 hours, were: severe necrotizing enterocolitis, infection, bronchopulmonary dysplasia, severe intracranial hemorrhage, cystic periventricular leukomalacia, and/or severe retinopathy of prematurity. Regression models assessed yearly changes, adjusting for study center, race/ethnicity, GA, birthweight for GA, and sex. Results: Use of antenatal corticosteroids increased from 1993 to 2012 (348/1431 [24%] to 1674/1919 [87%], p<0.001), as did cesarean delivery (625/1431 [44%] to 1227/1921 [64%], p<0.001). Delivery room intubation decreased from 1144/1433 (80%) in 1993 to 1253/1922 (65%) in 2012 (p<0.001). After increasing in the 1990s, postnatal steroid use declined to 141/1757 (8%) in 2004 (p<0.001), with no significant change thereafter. Although most infants were ventilated, continuous positive airway pressure without ventilation increased from 120/1666 (7%) in 2002 to 190/1756 (11%) in 2012 (p<0.001). Despite no improvement from 1993 to 2004, rates of late-onset sepsis declined between 2005 and 2012 for infants of each GA (median GA 26 weeks, 109/296 [37%] to 85/320 [27%], adjusted relative risk [aRR]: 0.93 [95% CI, 0.92?0.94]). Rates of other morbidities declined, but bronchopulmonary dysplasia increased between 2009 and 2012 for infants 26?27 weeks (26 weeks, 130/258 [50%] to 164/297 [55%], p<0.001). Survival increased between 2009 and 2012 for infants 23 weeks (41/152 [27%] to 50/150 [33%], aRR: 1.09 [95% CI, 1.05?1.14]) and 24 weeks (156/248 [63%] to 174/269 [65%], aRR: 1.05 [95% CI, 1.03?1.07]), with smaller relative increases for infants 25 and 27 weeks and no change for infants 22, 26 and 28 weeks. Survival without major morbidity increased approximately 2% per year for infants 25?28 weeks with no change for infants 22?24 weeks. Conclusions and Relevance: Among extremely preterm infants born at US academic centers over the last 20 years, changes in maternal and infant care practices and modest reductions in several morbidities were observed, although bronchopulmonary dysplasia increased. Survival increased most markedly for infants born at 23 and 24 weeks and survival without major morbidity increased for infants 25?28 weeks. These findings may be valuable in counselling families and developing novel interventions.
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JAMA 2015 ; 314 (10): 1039-51
