1. Among extremely preterm infants born at 22-28 weeks’ gestational age in 2013-2018 in the United States, 78.3% of infants survived to discharge, a significant improvement from 76.0% in 2008-2012.
2. Among infants born at less than 27 weeks’ gestational age, rehospitalization and severe neurodevelopmental impairment were common at 2-year follow-up.
Evidence Rating Level: 2 (Good)
Study Rundown: Although modern practices and treatment guidelines have greatly reduced mortality and morbidity in extremely preterm infants, on-going review of neonatal outcomes is needed to develop care strategies, guide interventions, and ultimately improve survival and quality of life outcomes. This observational study evaluated mortality, in-hospital morbidities, care practices, and neurodevelopmental and functional outcomes at 22-26 months’ corrected age for extremely preterm infants born in the United States between 2013 and 2018. The main outcomes were survival and in-hospital morbidities including necrotizing enterocolitis, infection, intracranial hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia. At 2-year follow-up, infants were assessed for health and functional outcomes including neurodevelopment, cerebral palsy, vision, hearing, rehospitalizations, and need for assistive devices. Data was compared to a similar cohort of preterm infants from 2008-2012. Among 10877 extremely preterm infants born in 2013-2018, 78.3% of infants survived to discharge, a significant improvement from 76.0% in 2008-2012. Among infants who survived to their 2-year follow-up, 49.9% had been rehospitalized and severe neurodevelopmental impairment occurred in 21.2%. A limitation of this study was that although the Neonatal Research Network cohort included a large and diverse sample size, it is an academic hospital-based database and thus, does not represent the sociodemographics of the entire US preterm population.
In-Depth [prospective cohort]: This study included 10877 infants (49.0% female) born at 22-28 weeks’ gestational age between January 2013 and December 2018, including 2566 infants who completed follow-up at 2 years’ corrected age. Data was collected from a registry for extremely preterm infants born at 19 US centers and compared to a similar cohort of infants from 2008-2012. Overall, 78.3% of infants survived to discharge (from 76.0% in 2008-2012; adjusted difference, 2.0%; 95%CI, 1.0%-2.9%). The incidence of all in-hospital morbidities were more likely in extremely preterm infants, including necrotizing enterocolitis (8.9%), early-onset infection (2.4%), late-onset infection (19.9%), intracranial hemorrhage (14.3%), retinopathy of prematurity (12.8%), and bronchopulmonary dysplasia (8.0%). Among 2566 infants evaluated at 2-year follow-up, 8.4% had cerebral palsy, 1.5% had bilateral blindness, 2.5% required hearing aids or cochlear implants, 49.9% had been rehospitalized, and 15.4% required mobility aids or other supportive devices. Lastly, in 2458 fully evaluated infants, 48.7% had no or mild neurodevelopmental impairment, 29.3% had moderate neurodevelopmental impairment, and 21.2% had severe neurodevelopmental impairment.
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