Predictors for Survival in Extreme Prematurity
Marianna Parker
Sara V. Bates
Intensive Care for Extreme Prematurity—Moving Beyond Gestational Age
Tyson JE, Parikh NA, Langer J, et al. N Engl J Med. 2008;358:1672–1681
Background
Decisions surrounding resuscitation of and intensive care for extremely preterm infants remain challenging due to outcome variability and dating inaccuracy. In most centers, intensive care is routinely administered after 25 weeks’ gestation, but practices differ for babies born at 22 to 24 weeks. Prior to this study, the effect of factors other than gestational age (GA) on survival and likelihood of severe neurodevelopmental disabilities was not well examined.
Objectives
To relate GA and other assessable perinatal factors to the likelihood of death or adverse neurologic outcomes in extremely preterm infants.
Methods
Prospective cohort study at 19 US centers from 1998 to 2003.
Patients
4,446 infants born at 22 to 25 weeks’ gestation. Select exclusion criteria: major congenital anomaly, birth weight (BW) <401 g, or BW >1,000 g or 97th percentile for GA suggesting dating inaccuracy.
Intervention
Multiple risk factors were assessed: mode of delivery, single vs. multiple birth, sex, corticosteroid treatment <7 days before delivery, race/ethnicity, and BW. Provision of intensive care was defined as initiation of mechanical ventilation. Standardized neurodevelopmental assessments were performed at corrected age of 18 to 22 months.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
