18 Jan Survival Chances Improving For Extremely Premature Babies, But Many Face Long Term Problems
MedicalResearch.com Interview with:
Edward Bell, MD
Professor of Pediatrics-Neonatology
Vice Chair for Faculty Development,
Stead Family Department of Pediatrics
Roy J. and Lucille A. Carver College of Medicine
University of Iowa
MedicalResearch.com: What is the background for this study?
Response: The National Institute of Child Health and Human Development, a branch of the National Institutes of Health (NIH), has supported the Neonatal Research Network (NRN) since 1986. The NRN, a group of US academic centers, is tasked with conducting research to improve the treatment and health outcomes of premature and critically-ill babies in US neonatal intensive care units (NICUs). Every few years, the NRN publishes reports on the survival rates and outcomes of surviving extremely premature babies, those born before 28 weeks of gestation. These reports help us to judge progress in the care and outcomes of these infants. This paper is the 9th in this series of reports but the first that includes not only survival and in-hospital outcomes but also outcomes at 2 years of age. MedicalResearch.com: What are the main findings?
Response: In this study of more than 10,000 infants born at 22-28 weeks’ gestational age between 2013 and 2018, 78.3% survived to hospital discharge. This figure was significantly higher than in the same Network in previous years, 76.0% in 2008-2012. (This is not a big percentage increase, but with over 10,000 infants, it means hundreds more survived who would have died in the earlier era.) Survival increased particularly at the lowest gestational ages, from 6.6% of live-born infants to 10.9% at 22 weeks and from 32.3% to 49.4% at 23 weeks. Infants born between 2013 and 2016 with gestational ages 22-26 weeks were evaluated at 2 years. Approximately half had moderate or severe neurodevelopmental impairment, whereas the other half had only mild or no neurodevelopmental impairment.
MedicalResearch.com: What should readers take away from your report?
Response: Survival chances are improving for extremely premature babies, even those at the earliest viable gestational ages, 22 and 23 weeks. Many of the complications of premature birth are becoming less common. Survivors are at risk of neurological or developmental problems, but half of surviving children have no significant long-term problems.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: More research is needed to further improve the survival and quality of life for these fragile babies.
One important area of focus should be on protecting the brain and improving brain development and neurological outcome.
MedicalResearch.com: Is there anything else you would like to add?
Response: One in 10 babies is born prematurely in the US. Premature birth has many causes, but most are not avoidable by the parents. This can happen to anyone. The infants in this study are just the extremely premature infants, who represent less than 1% of US births.
Bell EF, Hintz SR, Hansen NI, et al. Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018. JAMA. 2022;327(3):248–263. doi:10.1001/jama.2021.23580
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