Survival, morbidity, and resource use of infants of 25 weeks’ gestational age or less

Chan, Kevin; Ohlsson, Arne; Synnes, Anne; Lee, David S. C.; Chien, Li Yin; Lee, Shoo K.

doi:10.1067/mob.2001.115280

Cited by 108 publications

(84 citation statements)

References 21 publications

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“…Differences in this end-of-life decision policy may partially explain the large variation in survival rate between units. This may also be the case as seen in the large interhospital variation in delivery room survival rates (range: 41%-82%) as demonstrated by Chan et al 11 and in the present study (range: 33%-75%). Of 106 informative cases (data not shown) in 12 different NICUs, we could also find large differences in ethical practice with regard to the decisions of withholding curative care in the delivery room.…”

Section: Discussionsupporting

confidence: 80%

“…This was also clearly demonstrated in the EPICure study. 8 In the Canadian cohort 11 and the present study, almost two thirds of the surviving infants received postnatal steroids for prevention of CLD. Seventytwo percent of the EPICure cohort survivors received steroids postnatally.…”

Section: Discussionmentioning

confidence: 62%

“…In other population-based studies (United Kingdom, Canada, New Zealand, France), this number ranged from 23% to 29%. 8,[11][12][13] This strong association of extreme prematurity with multiple-gestation pregnancies in different surveys suggests a probable link with the use of assisted reproduction techniques. However, multiple gestation in these EPT infants was not associated with outcome variables (survival and shortterm major neuromorbidity or NICU-specific complications).…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, CS was not associated with higher survival in the EPICure cohort. 8 In the Canadian geographic cohort of infants from 22 to 25 weeks' gestation, the CS rate was 33% overall and 47% for infants of 25 weeks' GA. 11 The Canadian NICU Network found that abdominal delivery in EPT infants was associated with less severe ICH. 27 In a recent large, single-hospital study on 278 deliveries at 22 to 25 weeks, CS was associated with increased in-hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7] The aim of the present study was to examine GAspecific outcomes of a large population-based cohort of infants who were born at Յ26 weeks' gestation and cared for in all 19 perinatal centers of Belgium between January 1999 and December 2000 and to compare the results with those of other geographic GA-based cohorts available in the literature. [8][9][10][11][12][13][14][15] …”

mentioning

confidence: 99%

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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: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

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

Vanhaesebrouck

Allegaert²,

Bottu³

et al. 2004

Pediatrics

182

123

View full text Add to dashboard Cite

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Community Supports After Surviving Extremely Low-Birth-Weight, Extremely Preterm Birth

Hintz

Kendrick²,

Vohr³

et al. 2008

Arch Pediatr Adolesc Med

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Objective To determine special outpatient services (SOS) use, need, associated factors, and neurodevelopmental and functional outcomes among extremely preterm infants at 18 to 22 months’ corrected age. Design Retrospective analysis. Setting National Institute of Child Health and Human Development (NICHD) Neonatal Research Network. Participants Infants younger than 28 weeks’ gestational age who had been born weighing less than 1000 g at an NICHD Neonatal Research Network center from January 1, 1997, to December 31, 2000, and who were receiving follow-up at 18 to 22 months’ corrected age. Interventions Questionnaires were administered at the 18- to 22-month follow-up visit regarding SOS use since hospital discharge and the current need for SOS (social work, visiting nurse, medical specialty, early intervention, speech and language services, occupational therapy and physical therapy, and neurodevelopmental and behavioral services). Main Outcome Measures The use of and need for SOS were analyzed by gestational age. Logistic regression analysis identified factors independently associated with the use of more than 5 services and with the need for any services. Results Of 2315 infants, 54.7% used more than 3 SOS by 18 to 22 months, and 19.1% used 6 to 7 SOS. The need for any SOS was reported by approximately 37%. The following variables that were commonly associated with adverse neurodevelopmental outcomes were also associated with the use of more than 5 SOS: sepsis, birth weight, postnatal corticosteroid use, bronchopulmonary dysplasia, and cystic periventricular leukomalacia or grade 3 or 4 intraventricular hemorrhage. Male sex was associated with the need for any SOS. Although high SOS use was more likely among children with adverse neurodevelopmental outcomes, a reported need for SOS was common even among those with mild developmental impairment (39.7%) and mild cerebral palsy (42.2%). Conclusions High SOS use is common, has identifiable neonatal risk factors, and is associated with neurodevelopmental impairment. Extremely preterm survivors have substantial need for community supports regardless of their impairment level. Efforts to improve comprehensive delivery of family-centered community-based services are urgently needed.

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Poor Outcomes at Discharge Among Extremely Premature Infants

Kugelman

Bader²,

Lerner‐Geva³

et al. 2012

Arch Pediatr Adolesc Med

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Survival, morbidity, and resource use of infants of 25 weeks’ gestational age or less

Cited by 108 publications

References 21 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

Community Supports After Surviving Extremely Low-Birth-Weight, Extremely Preterm Birth

Poor Outcomes at Discharge Among Extremely Premature Infants

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