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Improved outcome of extremely premature infants in the 1990s
M S Paranka1, B A Yoder, W Brehm
1Department of Pediatrics, Keesler Air Force Base, MS 39534, USA.
Objective:
To study the impact of new treatment modalities on premature infants, we compared the effects of surfactant and antenatal steroid use on outcome in two military medical centers.
Study Design:
We performed a retrospective chart review of 234 infants delivered at 22 to 26 weeks estimated gestational age (EGA) at our institutions between 1986 and 1996. The patients were divided into two groups: the presurfactant group included deliveries from 1986 to 1989; and deliveries from 1990 to 1996 were in the surfactant group.
Results:
At 23 weeks EGA or less, there was only one survivor. At 24 weeks EGA, survival was improved in the surfactant group (46% vs. 5%; p < 0.005). Survival rates at 25 and 26 weeks EGA did not differ significantly. Combined survival at 24 to 26 weeks in the surfactant group exposed to antenatal steroids was 75% versus 44% in the presurfactant group (p = 0.02) Among survivors, the incidence of grade 3 or higher intraventricular hemorrhage was less in the surfactant group (18% vs. 42%; p = 0.038).
Conclusions:
Use of surfactant and antenatal steroids are associated with improved survival and decreased incidence of severe intraventricular hemorrhage among the most premature infants delivered in our institutions.