Neonatal outcomes of moderately preterm infants compared to extremely preterm infants

Abstract

BACKGROUND Extremely preterm infants (EPT, <29 weeks’ gestation) represent only 0.9% of births in the U.S., yet these infants are focus of most published research. Moderately preterm neonates (MPT, 29–336/7 weeks), are an understudied group of high-risk infants. METHODS Objective: To determine the neonatal outcomes of MPT across the gestational age spectrum, and to compare these to EPT. A prospective observational cohort was formed in 18 Level 3–4 NICUs in the Eunice Kennedy Shriver NICHD Neonatal Research Network. Participants included all MPT admitted to NICUs, and all EPT born at sites between January 2012 and November 2013. Antenatal characteristics, and neonatal morbidities were abstracted from records using pre-specified definitions by trained neonatal research nurses. RESULTS MPT infants experienced morbidities similar to, although at lower rates, than EPT infants. The main cause of mortality was congenital malformation, accounting for 43% of deaths. CNS injury occurred including intraventricular hemorrhage. Most MPT required respiratory support but sequelae such as bronchopulmonary dysplasia were rare. The primary contributors to hospitalization beyond 36 weeks’ gestation were inability to achieve adequate oral intake and persistent apnea. CONCLUSIONS MPT experience morbidity and prolonged hospitalization. Such morbidity deserves focused research to improve therapeutic and prevention strategies.

Mesenchymal Stem Cells for Severe Intraventricular Hemorrhage in Preterm Infants: Phase I Dose-Escalation Clinical Trial

“…The risk and severity of IVH directly correlate with degree of immaturity 3, and the improved survival of extremely preterm infants, enabled by recent advances in neonatal intensive care, has resulted in an increased number of preterm infants at high risk of developing severe IVH 4. More than 50% of preterm infants affected by severe (grade ≥3) IVH die or develop posthemorrhagic hydrocephalus (PHH) ultimately requiring shunt surgery in up to 40%–70% of cases 5, 6, 7.…”

Lung Ultrasound Score Predicts Surfactant Need in Extremely Preterm Neonates

“…9 Other authors have also shown that qualitative lung ultrasounds can be used to predict the need for intubation in neonates of variable GA and/or different causes of respiratory failure. 10,11 Extremely preterm neonates benefit the most from an optimized and timely surfactant administration because they are at a higher risk of long-term respiratory sequelae 12 and may require repeated surfactant treatment. 13 There are no data available on the use of a LUS in a homogeneous population of only extremely preterm neonates with RDS, and we hypothesize that LUS might be reliable in these patients.…”

Neonatal Morbidities among Moderately Preterm Infants with and without Exposure to Antenatal Corticosteroids

“…13 The Moderate Preterm Registry included infants born at GA 29 0/7 to 33 6/7 weeks and admitted prior to 72 hours of age at NRN centers. 13 All participating sites obtained approval from their Institutional Review Board prior to data collection. All sites, except three, received waiver of consent for collection of data.…”