Approach to infants born at 22 to 24 weeks' gestation: relationship to outcomes of more-mature infants.
OBJECTIVE
We sought to determine if a center's approach to care of premature infants at the youngest gestational ages (22-24 weeks' gestation) is associated with clinical outcomes among infants of older gestational ages (25-27 weeks' gestation).


METHODS
Inborn infants of 401 to 1000 g birth weight and 22 0/7 to 27 6/7 weeks' gestation at birth from 2002 to 2008 were enrolled into a prospectively collected database at 20 centers participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Markers of an aggressive approach to care for 22- to 24-week infants included use of antenatal corticosteroids, cesarean delivery, and resuscitation. The primary outcome was death before postnatal day 120 for infants of 25 to 27 weeks' gestation. Secondary outcomes were the combined outcomes of death or a number of morbidities associated with prematurity.


RESULTS
Our study included 3631 infants 22 to 24 weeks' gestation and 5227 infants 25 to 27 weeks' gestation. Among the 22- to 24-week infants, use of antenatal corticosteroids ranged from 28% to 100%, cesarean delivery from 13% to 65%, and resuscitation from 30% to 100% by center. Centers with higher rates of antenatal corticosteroid use in 22- to 24-week infants had reduced rates of death, death or retinopathy of prematurity, death or late-onset sepsis, death or necrotizing enterocolitis, and death or neurodevelopmental impairment in 25- to 27-week infants.


CONCLUSIONS
This study suggests that physicians' willingness to provide care to extremely low gestation infants as measured by frequency of use of antenatal corticosteroids is associated with improved outcomes for more-mature infants.
Department of Pediatrics, Duke University, Durham, North Carolina 27715, USA. brian.smith@duke.edu
P Brian
PB
Smith
Namasivayam
N
Ambalavanan
Lei
L
Li
C Michael
CM
Cotten
Matthew
M
Laughon
Michele C
MC
Walsh
Abhik
A
Das
Edward F
EF
Bell
Waldemar A
WA
Carlo
Barbara J
BJ
Stoll
Seetha
S
Shankaran
Abbot R
AR
Laptook
Rosemary D
RD
Higgins
Ronald N
RN
Goldberg
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002585:Cesarean Section / Q000639:trends; D005260:Female; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000502:physiology*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007235:Infant, Premature, Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D015931:Intensive Care, Neonatal; D008297:Male; D011446:Prospective Studies; D012151:Resuscitation / Q000706:statistics & numerical data; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones