title: Improved survival and neurodevelopmental outcomes among extremely premature infants born near the limit of viability.
abstract: BACKGROUND
  Infants born near the limit of viability are at high risk for death or adverse neurodevelopmental outcomes. It is unclear whether these outcomes have improved over the past 15 years.
  
  
  OBJECTIVE
  To determine if death and neurodevelopmental impairment have declined over the past 15 years in infants born at 22 to 24 weeks' gestation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  We identified infants born at 22 to 24 weeks' gestation in our center in two epochs: 1998-2004 (Epoch 1) and 2005-2011 (Epoch 2).
  
  
  METHODS
  The primary outcome, death or neurodevelopmental impairment, was evaluated at 17-25 months' corrected gestational age with neurologic exams and Bayley Scales of Infant Development. Perinatal characteristics, major morbidities, and outcomes were compared between epochs.
  
  
  RESULTS
  Birth weight and gestational age were similar between 170 infants in Epoch 1 and 187 infants in Epoch 2. Mortality was significantly lower in Epoch 2, 55% vs. 42% (p=0.02). Among surviving infants, late-onset sepsis (p<0.01), bronchopulmonary dysplasia (p<0.01), and surgical necrotizing enterocolitis (p=0.04) were less common in Epoch 2. Neurodevelopmental impairment among surviving infants declined from 68% in Epoch 1 to 47% in Epoch 2, p=0.02. Odds of death or NDI were significantly lower in Epoch 2 vs. Epoch 1, OR=0.31 (95% confidence interval; 0.16, 0.58).
  
  
  CONCLUSIONS
  Risk of death or neurodevelopmental impairment decreased over time in infants born at 22 to 24 weeks' gestation.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA. Electronic address: Noelle.Younge@duke.edu.
authors.forename: Noelle
authors.initials: N
authors.lastname: Younge
authors.affiliation: Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA.
authors.forename: P Brian
authors.initials: PB
authors.lastname: Smith
authors.affiliation: Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Gustafson
authors.affiliation: Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA.
authors.forename: William
authors.initials: W
authors.lastname: Malcolm
authors.affiliation: Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ashley
authors.affiliation: Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Cotten
authors.affiliation: Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA.
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Goldberg
authors.affiliation: Division of Neonatology, Department of Pediatrics, Duke University Medical Center, the Jean and George Brumley, Jr. Neonatal-Perinatal Institute, Durham, NC, USA.
authors.forename: Ricki F
authors.initials: RF
authors.lastname: Goldstein
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis / Q000453:epidemiology*; D002658:Developmental Disabilities / Q000175:diagnosis / Q000453:epidemiology*; D020345:Enterocolitis, Necrotizing / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D062071:Infant, Extremely Premature / Q000254:growth & development*; D007231:Infant, Newborn; D008297:Male
keywords: Extremely premature infants; Mortality; Neurodevelopmental outcomes