Jane E Brumbaugh1, Nellie I Hansen2, Edward F Bell3, Amaanti Sridhar2, Waldemar A Carlo4, Susan R Hintz5, Betty R Vohr6, Tarah T Colaizy3, Andrea F Duncan7, Myra H Wyckoff8, Michelle L Baack9, Matthew A Rysavy3, Sara B DeMauro10, Barbara J Stoll7, Abhik Das11, Rosemary D Higgins12. 1. Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota. 2. Social, Statistical, and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina. 3. Department of Pediatrics, University of Iowa, Iowa City. 4. Department of Pediatrics, University of Alabama at Birmingham. 5. Department of Pediatrics, Stanford University, Palo Alto, California. 6. Department of Pediatrics, Brown University, Providence, Rhode Island. 7. Department of Pediatrics, University of Texas Health Science Center at Houston. 8. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas. 9. Children's Health Research Center, Sanford Research, Sioux Falls, South Dakota. 10. Department of Pediatrics, University of Pennsylvania, Philadelphia. 11. Social, Statistical, and Environmental Sciences Unit, RTI International, Rockville, Maryland. 12. National Institute of Child Health and Human Development, Bethesda, Maryland.
Abstract
Importance: Birth weight (BW) is an important predictor of mortality and morbidity. At extremely early gestational ages (GAs), BW may influence decisions regarding initiation of resuscitation. Objective: To characterize outcomes of liveborn infants with a BW less than 400 g. Design, Setting, and Participants: This retrospective multicenter cohort study analyzed extremely preterm infants born between January 2008 and December 2016 within the National Institute of Child Health and Human Development Neonatal Research Network. Infants with a BW less than 400 g and a GA of 22 to 26 weeks were included. Active treatment was defined as the provision of any potentially lifesaving intervention after birth. Survival was analyzed for the entire cohort; neurodevelopmental impairment (NDI) was examined for those born between January 2008 and December 2015 (birth years with outcomes available for analysis). Neurodevelopmental impairment at 18 to 26 months' corrected age (CA) was defined as a Bayley Scales of Infant and Toddler Development, Third Edition, cognitive composite score less than 85, a motor composite score less than 85, moderate or severe cerebral palsy, gross motor function classification system score of 2 or greater, bilateral blindness, and/or hearing impairment. Data were analyzed from September 2017 to October 2018. Exposures: Birth weight less than 400 g. Main Outcomes and Measures: The primary outcome was survival to discharge among infants who received active treatment. Analysis of follow-up data was limited to infants born from 2008 to 2015 to ensure children had reached assessment age. Within this cohort, neurodevelopmental outcomes were assessed for infants who survived to 18 to 26 months' CA and returned for a comprehensive visit. Results: Of the 205 included infants, 121 (59.0%) were female, 133 (64.9%) were singletons, and 178 (86.8%) were small for gestational age. Almost half (101 of 205 [49.3%]) received active treatment at birth. A total of 26 of 205 infants (12.7%; 95% CI, 8.5-18.9) overall survived to discharge, and 26 of 101 actively treated infants (25.7%; 95% CI, 17.6-35.4) survived to discharge. Within the subset of infants with a BW less than 400 g and a GA of 22 to 23 weeks, 6 of 36 actively treated infants (17%; 95% CI, 6-33) survived to discharge. Among infants born between 2008 and 2015, 23 of 90 actively treated infants (26%; 95% CI, 17-36) survived to discharge. Two infants died after discharge, and 2 were lost to follow-up. Thus, 19 of 90 actively treated infants (21%; 95% CI, 13-31) were evaluated at 18 to 26 months' CA. Moderate or severe NDI occurred in 14 of 19 infants (74%). Conclusions and Relevance: Infants born with a BW less than 400 g are at high risk of mortality and significant morbidity. Although 21% of infants survived to 18 to 26 months' CA with active treatment, NDI was common among survivors.
Importance: Birth weight (BW) is an important predictor of mortality and morbidity. At extremely early gestational ages (GAs), BW may influence decisions regarding initiation of resuscitation. Objective: To characterize outcomes of liveborn infants with a BW less than 400 g. Design, Setting, and Participants: This retrospective multicenter cohort study analyzed extremely preterm infants born between January 2008 and December 2016 within the National Institute of Child Health and Human Development Neonatal Research Network. Infants with a BW less than 400 g and a GA of 22 to 26 weeks were included. Active treatment was defined as the provision of any potentially lifesaving intervention after birth. Survival was analyzed for the entire cohort; neurodevelopmental impairment (NDI) was examined for those born between January 2008 and December 2015 (birth years with outcomes available for analysis). Neurodevelopmental impairment at 18 to 26 months' corrected age (CA) was defined as a Bayley Scales of Infant and Toddler Development, Third Edition, cognitive composite score less than 85, a motor composite score less than 85, moderate or severe cerebral palsy, gross motor function classification system score of 2 or greater, bilateral blindness, and/or hearing impairment. Data were analyzed from September 2017 to October 2018. Exposures: Birth weight less than 400 g. Main Outcomes and Measures: The primary outcome was survival to discharge among infants who received active treatment. Analysis of follow-up data was limited to infants born from 2008 to 2015 to ensure children had reached assessment age. Within this cohort, neurodevelopmental outcomes were assessed for infants who survived to 18 to 26 months' CA and returned for a comprehensive visit. Results: Of the 205 included infants, 121 (59.0%) were female, 133 (64.9%) were singletons, and 178 (86.8%) were small for gestational age. Almost half (101 of 205 [49.3%]) received active treatment at birth. A total of 26 of 205 infants (12.7%; 95% CI, 8.5-18.9) overall survived to discharge, and 26 of 101 actively treated infants (25.7%; 95% CI, 17.6-35.4) survived to discharge. Within the subset of infants with a BW less than 400 g and a GA of 22 to 23 weeks, 6 of 36 actively treated infants (17%; 95% CI, 6-33) survived to discharge. Among infants born between 2008 and 2015, 23 of 90 actively treated infants (26%; 95% CI, 17-36) survived to discharge. Two infants died after discharge, and 2 were lost to follow-up. Thus, 19 of 90 actively treated infants (21%; 95% CI, 13-31) were evaluated at 18 to 26 months' CA. Moderate or severe NDI occurred in 14 of 19 infants (74%). Conclusions and Relevance: Infants born with a BW less than 400 g are at high risk of mortality and significant morbidity. Although 21% of infants survived to 18 to 26 months' CA with active treatment, NDI was common among survivors.
Authors: Mona Dür; Anna Röschel; Christiane Oberleitner-Leeb; Verena Herrmanns; Elisabeth Pichler-Stachl; Barbara Mattner; Silvia-Desiree Pernter; Martin Wald; Berndt Urlesberger; Herbert Kurz; Thomas Frischer; Karl Zwiauer; Angelika Berger Journal: PLoS One Date: 2021-11-15 Impact factor: 3.240
Authors: John Madar; Charles C Roehr; Sean Ainsworth; Hege Ersda; Colin Morley; Mario Rüdiger; Christiane Skåre; Tomasz Szczapa; Arjan Te Pas; Daniele Trevisanuto; Berndt Urlesberger; Dominic Wilkinson; Jonathan P Wyllie Journal: Notf Rett Med Date: 2021-06-02 Impact factor: 0.892
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