Research Article| January 01 2016 Trends in the Care and Outcomes of Extremely Premature Infants AAP Grand Rounds (2016) 35 (1): 10. https://doi.org/10.1542/gr.35-1-10 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Trends in the Care and Outcomes of Extremely Premature Infants. AAP Grand Rounds January 2016; 35 (1): 10. https://doi.org/10.1542/gr.35-1-10 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: infant, premature, trend Stoll BJ, Hansen NI, Bell EF, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993–2012. JAMA. 2015; 314(10): 1039– 1051; doi: https://doi.org/10.1001/jama.2015.10244Google Scholar Investigators from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) analyzed trends in the care and outcomes of extremely premature infants. Infants born at NRN-participating hospitals between 1993 and 2012 who were born at 22–28 weeks’ gestational age with a birth weight of 401–1,500 g were included. Maternal data were collected prospectively soon after birth and infant data were collected until death, hospital discharge, or 120 days of age. The 3 study outcomes were (1) maternal and infant care practices, including antenatal corticosteroid use, cesarean delivery, surfactant therapy, delivery room resuscitation, and respiratory support (eg, continuous positive airway pressure [CPAP] use); (2) neonatal morbidity, including necrotizing enterocolitis (NEC), early- and late-onset sepsis (defined as a culture positive for bacteria or fungi or antibiotic treatment lasting ≥5 days), intracranial hemorrhage (ICH), cystic periventricular leukomalacia (PVL), stage 3 retinopathy of prematurity (ROP) among infants hospitalized at 28 days, and bronchopulmonary dysplasia (BPD, defined as use of oxygen at 36 weeks’ postmenstrual age or at discharge if the infant was discharged prior to 36 weeks postmenstrual age); and (3) survival to discharge and survival without morbidities. Maternal and infant covariates included prenatal care, insulin-dependent diabetes, hypertension, gestational age, and birth weight. Analyses examined yearly changes over the 20-year study period among all infants and stratified by gestational age. There were 34,636 infants included in the analysis. Significant increases in antenatal corticosteroid usage, cesarean delivery, and surfactant therapy were observed over some or all of the study period as well as significant decreases in delivery room intubation. A significant increase in CPAP usage also occurred from 2002 to 2012 (7% vs 11%; P < .001). There was no change in the proportion of infants with early-onset sepsis over the study period, but there were significant declines in other morbidities: late-onset sepsis declined from 2005 to 2012 among all infants, NEC declined from 2008 to 2012 among all infants, ICH and PVL declined over the entire study period among 26- to 28-week infants, and ROP declined from 2003 to 2012 among all infants. BPD rose significantly from 2009 to 2012 among 26- to 27-week infants. A significant increase in overall survival was observed from 2009 to 2012 among infants born at 23 weeks (27% vs 33%; P < .001) and 24 weeks (63% vs 65%; P < .001). A significant increase in survival without major morbidity was observed for infants born at 25–28 weeks over the entire study period, with the proportion of 28-week infants surviving without major morbidity increasing from 43% in 1993 to 59% in 2012 (P < .001). The authors conclude that there have been modest declines in most morbidities, with the exception of BPD, and an improvement in survival among extremely... You do not currently have access to this content.