Changes in mortality and morbidities among infants born at less than 25 weeks during the post-surfactant era.
OBJECTIVE
To compare mortality and death or major morbidity (DOMM) among infants <25 weeks estimated gestational age (EGA) born during two post-surfactant era time periods.


METHODS
Comparative cohort study of very low birthweight (501-1500 g) infants <25 weeks EGA in the NICHD Neonatal Research Network born during two post-surfactant era time periods (group I, 1991-1994, n=1408; group II, 1995-1998, n=1348). Perinatal and neonatal factors were compared, and group related mortality and DOMM risk were evaluated.


RESULTS
Mortality was higher for group I (63.1% v 56.7%; p=0.0006). Antenatal steroids (ANS) and antenatal antibiotics (AABX), surfactant (p<0.0001), and bronchopulmonary dysplasia (p=0.0008) were more prevalent in group II. In a regression model that controlled for basic and delivery factors only, mortality risk was greater for group I than for group II (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2 to 1.7); the addition of AABX and surfactant, or ANS (OR 0.97, 95% CI 0.79 to 1.2) to the model appeared to account for this difference. There was no difference in DOMM (86.8% v 88.4%; p=0.2), but risk was lower for group I in regression models that included ANS (OR 0.70, 95% CI 0.52 to 0.94).


CONCLUSIONS
Survival to discharge was more likely during the more recent period because of group differences in ANS, AABX, and surfactant. However, this treatment shift may reflect an overall more aggressive management approach. More consistent application of treatment has led to improving survival of <25 week EGA infants during the post-surfactant era, but possibly at the cost of greater risk of major in-hospital morbidities.
Hintz
S R
SR
Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University Medical Center, 750 Welch Road, Suite 315, Palo Alto, CA 94304, USA. srhintz@stanford.edu
Poole
W K
WK
Wright
L L
LL
Fanaroff
A A
AA
Kendrick
D E
DE
Laptook
A R
AR
Goldberg
R
R
Duara
S
S
Stoll
B J
BJ
Oh
W
W
D000704:Analysis of Variance; D000890:Anti-Infective Agents / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality*; D019102:Infant, Very Low Birth Weight; D009017:Morbidity; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012044:Regression Analysis; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use
D000890:Anti-Infective Agents; D011663:Pulmonary Surfactants; D013256:Steroids
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