Improved outcome of extremely premature infants in the 1990s.
OBJECTIVE
To study the impact of new treatment modalities on premature infants, we compared the effects of surfactant and antenatal steroid use on outcome in two military medical centers.


METHODS
We performed a retrospective chart review of 234 infants delivered at 22 to 26 weeks estimated gestational age (EGA) at our institutions between 1986 and 1996. The patients were divided into two groups: the presurfactant group included deliveries from 1986 to 1989; and deliveries from 1990 to 1996 were in the surfactant group.


RESULTS
At 23 weeks EGA or less, there was only one survivor. At 24 weeks EGA, survival was improved in the surfactant group (46% vs. 5%; p < 0.005). Survival rates at 25 and 26 weeks EGA did not differ significantly. Combined survival at 24 to 26 weeks in the surfactant group exposed to antenatal steroids was 75% versus 44% in the presurfactant group (p = 0.02) Among survivors, the incidence of grade 3 or higher intraventricular hemorrhage was less in the surfactant group (18% vs. 42%; p = 0.038).


CONCLUSIONS
Use of surfactant and antenatal steroids are associated with improved survival and decreased incidence of severe intraventricular hemorrhage among the most premature infants delivered in our institutions.
Paranka
M S
MS
Department of Pediatrics, Keesler Air Force Base, MS 39534, USA.
Yoder
B A
BA
Brehm
W
W
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000188:drug therapy*; D002552:Cerebral Ventricles; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D006819:Hyaline Membrane Disease / Q000188:drug therapy*; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008889:Military Personnel; D008922:Mississippi; D007752:Obstetric Labor, Premature / Q000188:drug therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods*; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012189:Retrospective Studies; D013256:Steroids; D016019:Survival Analysis; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D011663:Pulmonary Surfactants; D013256:Steroids