Survival and Major Morbidity of Extremely Preterm Infants: A Population-Based Study

Anderson, James G.; Baer, Rebecca J.; Partridge, John Colin; Kuppermann, Miriam; Franck, Linda S.; Rand, Larry; Jelliffe‐Pawlowski, Laura L.; Rogers, Elizabeth E.

doi:10.1542/peds.2015-4434

Cited by 137 publications

(101 citation statements)

References 53 publications

(51 reference statements)

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“…We have developed cannulas for rapid insertion and anticipate the ability to cannulate a human umbilical cord and initiate circuit flow in <2 min that is well within the window of time that is critical for fetal brain oxygenation52. This would, at least initially, be done via a modified ‘EXIT' procedure53 in the 50–60% of extreme preterm deliveries that can be anticipated and delivered by caesarean section54. The requirement for an EXIT procedure will require centre expertise and introduce additional risk and potential long-term hysterotomy-related morbidity for the mother and these risks will need to be incorporated into nondirective counselling before the procedure.…”

Section: Discussionmentioning

confidence: 99%

An extra-uterine system to physiologically support the extreme premature lamb

et al. 2017

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In the developed world, extreme prematurity is the leading cause of neonatal mortality and morbidity due to a combination of organ immaturity and iatrogenic injury. Until now, efforts to extend gestation using extracorporeal systems have achieved limited success. Here we report the development of a system that incorporates a pumpless oxygenator circuit connected to the fetus of a lamb via an umbilical cord interface that is maintained within a closed ‘amniotic fluid' circuit that closely reproduces the environment of the womb. We show that fetal lambs that are developmentally equivalent to the extreme premature human infant can be physiologically supported in this extra-uterine device for up to 4 weeks. Lambs on support maintain stable haemodynamics, have normal blood gas and oxygenation parameters and maintain patency of the fetal circulation. With appropriate nutritional support, lambs on the system demonstrate normal somatic growth, lung maturation and brain growth and myelination.

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Section: Discussionmentioning

confidence: 99%

An extra-uterine system to physiologically support the extreme premature lamb

et al. 2017

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“…Recent advances in neonatal intensive care, including lung‐protective ventilator care strategies, moved the focus of BPD from severe lung injury in relatively mature preterm infants to the interruption of normal lung development in extremely preterm infants . These advances also increased the survival rate of more premature infants with lower birth weight for gestational age such as SGA and those with severe BPD . Therefore, it is crucial to determine whether being SGA in prematurity might lead to a worse clinical course related with poor pulmonary function in severe BPD cases…”

Section: Discussionmentioning

confidence: 99%

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

Kim

Eun

et al. 2019

Pediatric Pulmonology

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Objectives To determine significant indices for assessing the pulmonary function of infants according to bronchopulmonary dysplasia (BPD) severity and to evaluate whether small for gestational age (SGA) could affect pulmonary function in BPD. Methods We evaluated 117 preterm infants who had undergone tidal breathing flow‐volume loop and multiple‐breath washout analyses within 7 months after birth. We categorized preterm infants according to BPD severity into mild/moderate BPD (n = 86), severe BPD (n = 21), and without BPD (n = 10) and the presence of SGA or appropriate gestational age (AGA) using the Fenton growth chart. We evaluated nine healthy term infants as controls. Results The tidal breathing ratio (time to peak expiratory flow/expiratory time [tPEF/tE]) was significantly lower in infants with severe BPD than in those with mild/moderate BPD. Lung clearance index (LCI) was not different based on BPD severity. In the correlation analysis after adjusting for gestational age and sex, tPEF/tE was correlated with the duration of mechanical ventilation (r = −0.347, P < .001) and the duration of oxygen supply (r = −0.248, P = .013) in infants with BPD. The proportion of “lower tPEF/tE,” defined as below the cut‐off value, was greater in SGA infants (P = .017), while no significant difference was seen in the percentage of “higher LCI,” defined as above the cut‐off value between SGA and AGA infants. Conclusions In infants with BPD, tPEF/tE could be a useful pulmonary index which shows lower values in severe BPD. The finding of SGA in infants with BPD could be associated with poor pulmonary function related to the tPEF/tE values.

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“…It accounts for two-thirds of all infant deaths in the USA, about 15,000 every year [2]. Furthermore, survivors of prematurity, especially extreme prematurity (<28 weeks), are at risk for severe morbidities that can impact long-term outcomes [3,4]. …”

Section: Introductionmentioning

confidence: 99%

Racial and Ethnic Disparities in Preterm Infant Mortality and Severe Morbidity: A Population-Based Study

et al. 2017

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Background: Disparities exist in the rates of preterm birth and infant mortality across different racial/ethnic groups. However, only a few studies have examined the impact of race/ethnicity on the outcomes of premature infants. Objective: To report the rates of mortality and severe neonatal morbidity among multiple gestational age (GA) groups stratified by race/ethnicity. Methods: A retrospective cohort study utilizing linked birth certificate, hospital discharge, readmission, and death records up to 1 year of life. Live-born infants ≤36 weeks born in the period 2007-2012 were included. Maternal self-identified race/ethnicity, as recorded on the birth certificate, was used. ICD-9 diagnostic and procedure codes captured neonatal morbidities (intraventricular hemorrhage, retinopathy of prematurity, periventricular leukomalacia, bronchopulmonary dysplasia, and necrotizing enterocolitis). Multiple logistic regression was performed to evaluate the impact of race/ethnicity on mortality and morbidity, adjusting for GA, birth weight, sex, and multiple gestation. Results: Our cohort totaled 245,242 preterm infants; 26% were white, 46% Hispanic, 8% black, and 12% Asian. At 22-25 weeks, black infants were less likely to die than white infants (odds ratio [OR] 0.76; 95% confidence interval [CI] 0.62-0.94). However, black infants born at 32-34 weeks (OR 1.64; 95% CI 1.15-2.32) or 35-36 weeks (OR 1.57; 95% CI 1.00-2.24) were more likely to die. Hispanic infants born at 35-36 weeks were less likely to die than white infants (OR 0.66; 95% CI 0.50-0.87). Racial disparities at different GAs were also detected for severe morbidities. Conclusions: The impact of race/ethnicity on mortality and severe morbidity varied across GA categories in preterm infants. Disparities persisted even after adjusting for important potential confounders.

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Survival and Major Morbidity of Extremely Preterm Infants: A Population-Based Study

Cited by 137 publications

References 53 publications

An extra-uterine system to physiologically support the extreme premature lamb

An extra-uterine system to physiologically support the extreme premature lamb

Small for gestational age birth may increase airflow limitation in bronchopulmonary dysplasia

Racial and Ethnic Disparities in Preterm Infant Mortality and Severe Morbidity: A Population-Based Study

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