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Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g.

Publication ,  Journal Article
Brumbaugh, JE; Hansen, NI; Bell, EF; Sridhar, A; Carlo, WA; Hintz, SR; Vohr, BR; Colaizy, TT; Duncan, AF; Wyckoff, MH; Baack, ML; Rysavy, MA ...
Published in: JAMA Pediatr
May 1, 2019

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.

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Published In

JAMA Pediatr

DOI

EISSN

2168-6211

Publication Date

May 1, 2019

Volume

173

Issue

5

Start / End Page

434 / 445

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Prognosis
  • Neurodevelopmental Disorders
  • Male
  • Infant, Premature, Diseases
  • Infant, Newborn
  • Infant, Extremely Premature
  • Infant, Extremely Low Birth Weight
  • Infant
 

Citation

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Brumbaugh, J. E., Hansen, N. I., Bell, E. F., Sridhar, A., Carlo, W. A., Hintz, S. R., … National Institute of Child Health and Human Development Neonatal Research Network, . (2019). Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g. JAMA Pediatr, 173(5), 434–445. https://doi.org/10.1001/jamapediatrics.2019.0180
Brumbaugh, Jane E., Nellie I. Hansen, Edward F. Bell, Amaanti Sridhar, Waldemar A. Carlo, Susan R. Hintz, Betty R. Vohr, et al. “Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g.JAMA Pediatr 173, no. 5 (May 1, 2019): 434–45. https://doi.org/10.1001/jamapediatrics.2019.0180.
Brumbaugh JE, Hansen NI, Bell EF, Sridhar A, Carlo WA, Hintz SR, et al. Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g. JAMA Pediatr. 2019 May 1;173(5):434–45.
Brumbaugh, Jane E., et al. “Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g.JAMA Pediatr, vol. 173, no. 5, May 2019, pp. 434–45. Pubmed, doi:10.1001/jamapediatrics.2019.0180.
Brumbaugh JE, Hansen NI, Bell EF, Sridhar A, Carlo WA, Hintz SR, Vohr BR, Colaizy TT, Duncan AF, Wyckoff MH, Baack ML, Rysavy MA, DeMauro SB, Stoll BJ, Das A, Higgins RD, National Institute of Child Health and Human Development Neonatal Research Network. Outcomes of Extremely Preterm Infants With Birth Weight Less Than 400 g. JAMA Pediatr. 2019 May 1;173(5):434–445.

Published In

JAMA Pediatr

DOI

EISSN

2168-6211

Publication Date

May 1, 2019

Volume

173

Issue

5

Start / End Page

434 / 445

Location

United States

Related Subject Headings

  • Risk Factors
  • Retrospective Studies
  • Prognosis
  • Neurodevelopmental Disorders
  • Male
  • Infant, Premature, Diseases
  • Infant, Newborn
  • Infant, Extremely Premature
  • Infant, Extremely Low Birth Weight
  • Infant