Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018

医学儿科急诊医学梅德林重症监护医学法学政治学

作者

Edward F. Bell,Susan R. Hintz,Nellie I. Hansen,Carla Bann,Myra H. Wyckoff,Sara B. DeMauro,Michele C. Walsh,Betty R. Vohr,Barbara J. Stoll,Waldemar A. Carlo,Krisa P. Van Meurs,Matthew A. Rysavy,Ravi M. Patel,Stephanie L. Merhar,Pablo J. Sánchez,Abbot R. Laptook,Anna Maria Hibbs,C. Michael Cotten,Carl T. D’Angio,Sarah Winter,Janell Fuller,Abhik Das,Namasivayam Ambalavanan,Kirstin J. Bailey,Fred J. Biasini,Stephanie A. Chopko,Monica V. Collins,Shirley S. Cosby,Kristy A. Domnanovich,Chantel J. Jno-Finn,Morissa Ladinsky,Tara E. McNair,Mary Beth Moses,Myriam Peralta-Carcelén,Vivien A. Phillips,Julie Preskitt,Richard V. Rector,Kimberlly Stringer,Sally Whitley,Sheree York Chapman,Barbara Alksninis,Robert T. Burke,Angelita M. Hensman,Martin Keszler,Mary Lenore Keszler,Andrea M. Knoll,Theresa M. Leach,Elizabeth McGowan,Lucille St. Pierre,Elisa Vieira,Victoria E. Watson,Stephanie Guilford,Michelle Hartley-McAndrew,Satyan Lakshminrusimha,Emily Li,Anne Marie Reynolds,Michael G. Sacilowski,Ashley Williams,William Zorn,Harriet Friedman,Nancy S. Newman,Bonnie S. Siner,Deanne E. Wilson-Costello,Tanya E. Cahill,Teresa L. Gratton,Cathy Grisby,Kristin Kirker,Brenda B. Poindexter,Kurt Schibler,Sandra Wuertz,Kimberly Yolton,Richard A. Polin,Samuel B. Adams,Luc P. Brion,Maria Magdalena Leon,Frances Eubanks,Alicia Guzman,Elizabeth T. Heyne,Roy J. Heyne,Lizette E. Lee,E. Rebecca McDougald,Lara Pavageau,Pollieanna Sepulveda,Catherine Twell Boatman,Diana M. Vasil,Azucena Vera,Jillian Waterbury,Patricia L. Ashley,Joanne Finkle,Kimberley A. Fisher,Ronald N. Goldberg,Ricki F. Goldstein,Kathryn E. Gustafson,Deesha Mago-Shah,William Malcolm,Ira Adams‐Chapman,Diane I. Bottcher,David P. Carlton,Sheena L. Carter,Ellen C. Hale,Salathiel Kendrick-Allwood,Judith Laursen,Yvonne Loggins,Colleen Mackie,Maureen Mulligan LaRossa,Amy Sanders,Gloria Smikle,Lynn Wineski,Elizabeth Allain,Julie Arldt-McAlister,Fatima Boricha,Allison G. Dempsey,Andrea F. Duncan,Carmen Garcia,Donna J. Hall,Janice John,Kathleen A. Kennedy,Amir Khan,M. Layne Lillie,Karen Martin,Georgia E. McDavid,Shannon L. McKee,Ricardo A. Mosquera,Michelle Poe,Tina Reddy,Kimberly Rennie,Shawna Rodgers,Daniel Sperry,Emily K. Stephens,Jon E. Tyson,Sharon L. Wright,Heidi M. Harmon,Dianne E. Herron,Abbey C. Hines,Carolyn Lytle,Lu-Ann Papile,Lucy Smiley,Gregory M. Sokol,Jane E. Brumbaugh,Tarah T. Colaizy,Diane L. Eastman,Claire A. Goeke,Karen Johnson,Mendi L. Schmelzel,Jacky R. Walker,John A. Widness,Donia B. Bass,Dan L. Ellsbury,Tracy L. Tud,Lisa Gaetano,Cheri Gauldin,Anne Holmes,Kathy Johnson,Howard W. Kilbride,Eugenia K. Pallotto,Prabhu S. Parimi,Allison Scott,William E. Truog,Nancy Batterson,Hallie Baugher,Demi R. Beckford,Stephanie Burkhardt,Helen Carey,Michelle Chao,Courtney Cira,Erna Clark,Brittany DeSantis,Erin Fearns,Christine A. Fortney,Aubry Fowler,Jennifer L. Grothause,Julie Gutentag,Cole Hague,Sudarshan R. Jadcherla,Sarah A. Keim,Katelyn Levengood,Patricia Luzader,Nathalie L. Maitre,Laura Marzec,Jacqueline McCool,Bethany Miller,Leif D. Nelin,Mary Ann Nelin,Julia L. Newton,Courtney Park,Lindsay Pietruszewski,Jessica Purnell,Julie C. Shadd,Jonathan L. Slaughter,Kristi Small,Melanie Stein,Margaret Sullivan,Rox Ann Sullivan,Christopher J. Timan,Kyrstin Warnimont,Keith Owen Yeates,Lina Yossef‐Salameh,Andrew A. Bremer,Rosemary D. Higgins,Stephanie Wilson Archer,Soraya Abbasi,Judy Bernbaum,Aasma S. Chaudhary,Dara M. Cucinotta,Eric C. Eichenwald,Marsha Gerdes,Sarvin Ghavam,Hallam Hurt,Haresh Kirpalani,Toni Mancini,Barbara Schmidt,Jonathan Snyder,Kristina Ziolkowski,Kyle Binion,Melissa Bowman,Elizabeth Boylin,Kelly R. Coleman,Caitlin Fallone,Osman Farooq,Ronnie Guillet,Cassandra A. Horihan,Julianne Hunn,Rosemary L. Jensen,Rachel Jones,Jennifer Kachelmeyer,Alison Kent,Kimberly G. McKee,Joan Merzbach,Gary J. Myers,Constance Orme,Diane Prinzing,Daisy Rochez,Mary Rowan,Premini Sabaratnam,Ann Marie Scorsone,Holly I.M. Wadkins,Kelley Yost,Margaret M. Crawford,Jenna Gabrio,Marie G. Gantz,Jamie E. Newman,Jeanette O’Donnell Auman,Lindsay Parlberg,Carolyn M. Petrie Huitema,Dennis Wallace,Kristin M. Zaterka-Baxter,Michelle Baack,Megan Broadbent,Chelsey Elenkiwich,Megan M. Henning,Laurie A. Hogden,Marian M. Adams,Dona Bahmani,M. Bethany Ball,Barbara Bentley,Valerie Y. Chock,Maria Elena DeAnda,Anne M. DeBattista,Beth Earhart,Lynne C. Huffman,Casey E. Krueger,Ryan E. Lucash,Melinda S. Proud,Elizabeth N. Reichert,David K. Stevenson,Heather Taylor,Hali E. Weiss,R. Jordan Williams,Teresa Chanlaw,Uday Devaskar,Meena Garg,Rachel Geller,Isabell B. Purdy,Janice Bernhardt,Carl Bose,Gennie Bose,Matthew M. Laughon,Jennifer Talbert,Diane Warner,Janice Wereszczak,Conra Backstrom Lacy,Carol H. Hartenberger,Elizabeth Kuan,Jean Lowe,Robin K. Ohls,Mary Hanson,Sandra Sundquist Beauman,Kristi L. Watterberg,John Barks,Martha Carlson,Mary Christensen,Diane F. White,Stephanie A. Wiggins,Shawna Baker,Mariana Baserga,Jill Burnett,Susan Christensen,Sean Cunningham,Brandy Davis,Jennifer O. Elmont,Roger G. Faix,Becky Hall,Erika R. Jensen,Manndi C. Loertscher,Trisha Marchant,Earl Maxson,Kandace M. McGrath,Hena G. Mickelsen,Stephen D. Minton,Galina Morshedzadeh,Dilys M. Parry,Carrie A. Rau,Susan T. Schaefer,Mark J. Sheffield,Kelly Stout,Ashley L. Stuart,Kimberlee Weaver-Lewis,Kathryn D. Woodbury,Bradley A. Yoder,Alexandra Bentley,Laura Edwards,Stephen D. Kicklighter,Ginger Rhodes-Ryan,Donna L. White,Prashant Agarwal,Monika Bajaj,Rebecca Bara,Sanjay Chawla,Kirsten Childs,Melissa February,Laura A. Goldston,Eunice Woldt,Girija Natarajan,Athina Pappas,Seetha Shankaran,Beena G. Sood

出处

期刊：JAMA [American Medical Association]
日期：2022-01-18 卷期号：327 (3): 248-248 被引量：376

链接

unm.edu nih.gov nih.govdoi.org

标识

DOI：10.1001/jama.2021.23580

摘要

Importance

Despite improvement during recent decades, extremely preterm infants continue to contribute disproportionately to neonatal mortality and childhood morbidity.

Objective

To review survival, in-hospital morbidities, care practices, and neurodevelopmental and functional outcomes at 22-26 months' corrected age for extremely preterm infants.

Design, Setting, and Participants

Prospective registry for extremely preterm infants born at 19 US academic centers that are part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. The study included 10 877 infants born at 22-28 weeks' gestational age between January 1, 2013, and December 31, 2018, including 2566 infants born before 27 weeks between January 1, 2013, and December 31, 2016, who completed follow-up assessments at 22-26 months' corrected age. The last assessment was completed on August 13, 2019. Outcomes were compared with a similar cohort of infants born in 2008-2012 adjusting for gestational age.

Exposures

Extremely preterm birth.

Main Outcomes and Measures

Survival and 12 in-hospital morbidities were assessed, including necrotizing enterocolitis, infection, intracranial hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia. Infants were assessed at 22-26 months' corrected age for 12 health and functional outcomes, including neurodevelopment, cerebral palsy, vision, hearing, rehospitalizations, and need for assistive devices.

Results

The 10 877 infants were 49.0% female and 51.0% male; 78.3% (8495/10848) survived to discharge, an increase from 76.0% in 2008-2012 (adjusted difference, 2.0%; 95% CI, 1.0%-2.9%). Survival to discharge was 10.9% (60/549) for live-born infants at 22 weeks and 94.0% (2267/2412) at 28 weeks. Survival among actively treated infants was 30.0% (60/200) at 22 weeks and 55.8% (535/958) at 23 weeks. All in-hospital morbidities were more likely among infants born at earlier gestational ages. Overall, 8.9% (890/9956) of infants had necrotizing enterocolitis, 2.4% (238/9957) had early-onset infection, 19.9% (1911/9610) had late-onset infection, 14.3% (1386/9705) had severe intracranial hemorrhage, 12.8% (1099/8585) had severe retinopathy of prematurity, and 8.0% (666/8305) had severe bronchopulmonary dysplasia. Among 2930 surviving infants with gestational ages of 22-26 weeks eligible for follow-up, 2566 (87.6%) were examined. By 2-year follow-up, 8.4% (214/2555) of children had moderate to severe cerebral palsy, 1.5% (38/2555) had bilateral blindness, 2.5% (64/2527) required hearing aids or cochlear implants, 49.9% (1277/2561) had been rehospitalized, and 15.4% (393/2560) required mobility aids or other supportive devices. Among 2458 fully evaluated infants, 48.7% (1198/2458) had no or mild neurodevelopmental impairment at follow-up, 29.3% (709/2419) had moderate neurodevelopmental impairment, and 21.2% (512/2419) had severe neurodevelopmental impairment.

Conclusions and Relevance

Among extremely preterm infants born in 2013-2018 and treated at 19 US academic medical centers, 78.3% survived to discharge, a significantly higher rate than for infants born in 2008-2012. Among infants born at less than 27 weeks' gestational age, rehospitalization and neurodevelopmental impairment were common at 2 years of age.

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