Survival and follow-up of infants born at 23 to 26 weeks of gestational age: Effects of surfactant therapy

Ferrara, Teresa; Hoekstra, Ronald; Couser, Robert J.; Gaziano, Emanuel P.; Calvin, Steven E.; Payne, Nathaniel R.; Fangman, John

doi:10.1016/s0022-3476(94)70266-7

Cited by 83 publications

(35 citation statements)

References 19 publications

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“…30 Although on physiologic grounds the absence of any beneficial effect of surfactant treatment before 26 weeks might be presumed, the administration of surfactant has been estimated to benefit some EPT infants. 4,31,32 Eighty-four percent of admitted infants in the EPICure study 8 and 78% in ours received surfactant, but death rates were not affected by the use of surfactant. This is in contrast to the retrospective study by Ferrera et al 32 reporting an improvement in survival from 55% to 73% for the infants (23-26 weeks) who were treated compared with those who were not treated with surfactant.…”

Section: Discussionmentioning

confidence: 56%

“…4,31,32 Eighty-four percent of admitted infants in the EPICure study 8 and 78% in ours received surfactant, but death rates were not affected by the use of surfactant. This is in contrast to the retrospective study by Ferrera et al 32 reporting an improvement in survival from 55% to 73% for the infants (23-26 weeks) who were treated compared with those who were not treated with surfactant. A large retrospective cohort study of 891 liveborn infants of 23 to 26 weeks' gestation (421 presurfactant and 470 postsurfactant) in Canada showed no secular change in overall mortality since the introduction of rescue therapy with natural surfactant.…”

Section: Discussionmentioning

confidence: 56%

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The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

Vanhaesebrouck

Allegaert²,

Bottu³

et al. 2004

Pediatrics

182

123

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ABSTRACT. Objective. To determine mortality and morbidity at discharge from the hospital of a large population-based cohort of infants who were born at <26 weeks' gestation.Methods. Perinatal data were collected on extremely preterm infants who were alive at the onset of labor and born between January 1, 1999, and December 31, 2000, in all 19 Belgian perinatal centers.Results. A total of 525 infants were recorded. Lifesupporting care was provided to 322 liveborn infants, 303 of whom were admitted for intensive care. The overall survival rate of liveborn infants was 54%. Of the infants who were alive at the age of 7 days, 82% survived to discharge. Vaginal delivery, shorter gestation, air leak, longer ventilator dependence, and higher initial oxygen need all were independently associated with death; gender, plurality, and surfactant therapy were not. Among the 175 survivors, 63% had 1 or more of the 3 major adverse outcome variables at the time of discharge (serious neuromorbidity, chronic lung disease at 36 weeks' postmenstrual age, or treated retinopathy of prematurity). The chance of survival free from serious neonatal morbidity at the time of hospital discharge was <15% (21 of 158) for the admitted infants with a gestation <26 weeks.Conclusions. If for the time being prolongation of pregnancy is unsuccessful, then outcome perspectives should be discussed and treatment options including nonintervention explicitly be made available to parents of infants of <26 weeks' gestation within the limits of medical feasibility and appropriateness. Pediatrics 2004; 114:663-675; extreme prematurity, mortality, morbidity, population-based cohort.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 56%

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

Vanhaesebrouck

Allegaert²,

Bottu³

et al. 2004

Pediatrics

182

123

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“…9,21,23,28 -30 More active treatment, ie, cesarean section and active resuscitation, of these infants does not always improve the outcome, 30 although surfactant treatment has been found beneficial. 31 The study by Emsley et al 9 showed improved survival of infants born at 23 to 25 GWs between 1984 and 1994 but showed a significant rise in disability rates. The deteriorated outcome was primarily caused by visual impairments, whereas the incidence of cerebral palsy remained constant.…”

Section: Figmentioning

confidence: 98%

A National Short-Term Follow-Up Study of Extremely Low Birth Weight Infants Born in Finland in 1996–1997

Heinonen²,

et al. 2001

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ABSTRACT. Objectives. The aims of this prospective nationwide investigation were to establish the birth rate, mortality, and morbidity of extremely low birth weight (ELBW) infants in Finland in 1996 -1997, and to analyze risk factors associated with poor outcome.Participants and Methods. The study population included all stillborn and live-born ELBW infants (birth weight: <1000 g; gestational age: at least 22 gestational weeks [GWs]), born in Finland between January 1, 1996 and December 31, 1997. Surviving infants were followed until discharge or to the age corresponding with 40 GWs. National ELBW infant register data with 101 prenatal and postnatal variables were used to calculate the mortality and morbidity rates. A total of 32 variables were included in risk factor analysis. The risk factors for death and intraventricular hemorrhage (IVH) of the live-born infants as well as for retinopathy of prematurity (ROP) and oxygen dependency of the surviving infants were analyzed using logistic regression models.Results. A total of 529 ELBW infants (.4% of all newborn infants) were born during the 2-year study. The perinatal mortality of ELBW infants was 55% and accounted for 39% of all perinatal deaths. Of all ELBW infants, 34% were stillborn, 21% died on days 0 through 6, and 3% on days 7 though 28. Neonatal mortality was 38% and postneonatal mortality was 2%. Of the infants who were alive at the age of 4 days, 88% survived. In infants surviving >12 hours, the overall incidence of respiratory distress syndrome (RDS) was 76%; of blood culture-positive septicemia, 22%; of IVH grades II through IV, 20%; and of necrotizing enterocolitis (NEC) with bowel perforation, 9%. The rate of IVH grades II through IV and NEC with bowel perforation decreased with increasing gestational age, but the incidence of RDS did not differ significantly between GWs 24 to 29. A total of 5 infants (2%) needed a shunt operation because of posthemorrhagic ventricular dilatation. Two hundred eleven ELBW infants (40% of all and 60% of live-born infants) survived until discharge or to the age corresponding with 40 GWs. The oxygen dependency rate at the age corresponding to 36 GWs was 39%, and 9% had ROP stage III-V. Neurological status was considered completely normal in 74% of the surviving infants. The proportions of infants born at 22 to 23, 24 to 25, 26 to 27, and 28 to 29 GWs with at least one disability (ROP, oxygen dependency, or abnormal neurological status) at the age corresponding to 36 GWs were 100%, 62%, 51%, and 45%, respectively. Birth weight <600 g and gestational age <25 GWs were the independent risks for death and short-term disability. The primary risk factor for IVH grades II through IV was RDS. Low 5-minute Apgar scores predicted poor prognosis, ie, death or IVH, and antenatal steroid treatment to mothers with threatening premature labor seemed to protect infants against these. Some differences were found in the mortality rates between the 5 university hospital districts: neonatal mortality was significantly lower (25% vs 44%) in...

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“…The incidence of neurodevelopmental problems in the surfactant-treated children in this trial was similar to that reported in children born preterm before the introduction of surfactants into clinical medicine. 102,103,107,109,110 Thus, it is difficult to generalize the frequency and severity of nonpulmonary morbidity at adolescence in those who received surfactant therapy as newborn infants. ** However, we can conclude that surfactant therapy increases survival without altering the incidence of neurosensory and developmental disabilities.…”

Section: Surfactant and Nonpulmonary Outcomesmentioning

confidence: 99%

Surfactant-Replacement Therapy for Respiratory Distress in the Preterm and Term Neonate

Engle¹

2008

Pediatrics

267

167

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Respiratory failure secondary to surfactant deficiency is a major cause of morbidity and mortality in preterm infants. Surfactant therapy substantially reduces mortality and respiratory morbidity for this population. Secondary surfactant deficiency also contributes to acute respiratory morbidity in late-preterm and term neonates with meconium aspiration syndrome, pneumonia/sepsis, and perhaps pulmonary hemorrhage; surfactant replacement may be beneficial for these infants. This statement summarizes indications, administration, formulations, and outcomes for surfactant-replacement therapy. The impact of antenatal steroids and continuous positive airway pressure on outcomes and surfactant use in preterm infants is reviewed. Because respiratory insufficiency may be a component of multiorgan dysfunction, preterm and term infants receiving surfactant-replacement therapy should be managed in facilities with technical and clinical expertise to administer surfactant and provide multisystem support.

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Survival and follow-up of infants born at 23 to 26 weeks of gestational age: Effects of surfactant therapy

Cited by 83 publications

References 19 publications

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

A National Short-Term Follow-Up Study of Extremely Low Birth Weight Infants Born in Finland in 1996–1997

Surfactant-Replacement Therapy for Respiratory Distress in the Preterm and Term Neonate

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