Survival and Neurodevelopmental Outcome of Preterm Infants Born at 22-24 Weeks of Gestational Age

Abstract

Background: The limits of viability in extremely premature infants are challenging for any neonatologists in developed countries. The neurological development and growth of extremely preterm infants have come to be the emerging issue following the management in the neonatal intensive care unit. Objective: To assess potential associations between changes in practice and survival/neurodevelopmental outcome, and clinical outcomes of extremely preterm infants born at the limit of viability studied in a tertiary center. Study Design: A retrospective study enrolled 51 infants who had no congenital disorders, and were born at 22-24 weeks of gestational age (GA) in 2000-2009 in our institution. Clinical variables and interventions were studied with regard to one-year survival and developmental quotient (DQ) at 3 years of age. Results: The one-year survival rate of 24 preterm infants born in 2005-2009 (79%) was higher than that of the 27 infants born in 2000-2004 (52%, p = 0.04). Infants born after 2005 underwent less tocolysis (54 vs. 94%, p < 0.01) and more frequently antenatal steroid therapy (32 vs. 6%, p = 0.01) than those born before 2004. The post-2005 survivors (n = 19) received more frequently indomethacin therapy (89 vs. 50%, p = 0.03) and early parenteral nutrition (95 vs. 36%, p < 0.01) than the pre-2004 survivors (n = 14). There were no differences in the proportion of infants who attained a DQ of >50 at 3 years of age between pre-2004 (9/13, 69%) and post-2005 groups (10/17, 59%). Multivariate analysis indicated that extremely premature birth at GA <24 weeks was the sole critical factor for a DQ of >50 in survivors. Conclusions: The perinatal care after 2005 improved the overall survival rate, but not the neurological outcome of preterm survivors at the limit of viability. Neurodevelopmental impairments were associated with extremely premature birth at GA <24 weeks.

Surgical Ligation for Patent Ductus Arteriosus in Extremely Premature Infants: Strategy to Reduce their Risk of Neurodevelopmental Impairment

“…However, no apparent difference in the ratio of the closure mode of the ductus arteriosus was detected between the current study (15.5%, 52.1%, and 32.4% of subjects in the spontaneous closure, COX inhibitor, and surgical ligation groups, respectively) and other clinical studies with ELBWIs, showing 14 to 28%, 42 to 63%, and 23 to 32%, respectively (Madan et al 2009;Adrouche-Amrani et al 2012;Youn et al 2013;Ochiai et al 2014). In addition, in the present study, the mortality of the subjects and the incidence of neurodevelopmental impairment were 9.9% (11/111 subjects) and 21.1% (15/71 subjects), respectively, both lower than those (13% and 44%, respectively) reported in a previous study (Madan et al 2009).…”

Auditing Neonatal Intensive Care: Is PREM a Good Alternative to CRIB for Mortality Risk Adjustment in Premature Infants?

“…With survival rates of (also extremely) premature infants improving, the focus has shifted towards long-term morbidity, especially neurodevelopmental outcome [4]. Ideally, NICU auditing considers both risk-adjusted mortality and morbidity [5].…”

“…Although outcomes of premature infants have improved, prematurity is still the most frequent cause of neonatal death [1,2] and one of the biggest challenges for neonatal intensive care [3,4]. Further improvement can be aided by auditing and comparing the quality of treatment [5].…”

Transición en la concepción de la viabilidad de prematuros extremos: análisis sociodiscursivo

“…En relación con los datos recogidos en la Figura 1, hay que señalar que, pese a que en nuestro país en los últimos años se ha producido un importante incremento de nacidos muy prematuramente (con <32 semanas de EG) y de recién nacidos de muy bajo peso, la tasa de supervivencia de estos bebés ha experimentado una mejora substancial, especialmente desde (Hernánde et al, 2005Guzmán et al, 2013;García et al, 2013;García-Muñoz et al, 2014), aunque las morbilidades no han disminuido en la misma medida, especialmente en el colectivo de prematuros extremos en los que se centra este artículo (Sánchez Luna 2014; Ochiai et al, 2014).…”