Developmental outcome of extremely preterm infants.

Area of Science:

• Neonatal Medicine
• Perinatal Care
• Public Health

Background:

• Institution-based studies show promising outcomes for extremely preterm infants within perinatal centers.
• Population-based studies are crucial to assess the community-wide impact of perinatal-neonatal care.
• Previous research indicated lower mortality and severe disability rates for infants born in perinatal centers.

Purpose of the Study:

• To evaluate the impact of perinatal-neonatal care on the entire community using population-based data.
• To examine the effectiveness of 'in utero transfer' and postnatal surfactant therapy on extremely preterm infants.

Main Methods:

• Analysis of population-based data from a geographically defined region.
• Comparison of outcomes for infants born within and outside perinatal centers.
• Assessment of the impact of specific interventions like 'in utero transfer' and surfactant therapy.

Main Results:

• Infants born within perinatal centers demonstrated significantly lower perinatal mortality and severe disability rates.
• 'In utero transfer' was associated with substantial improvements in survival and developmental outcomes.
• Postnatal surfactant therapy doubled survival rates for infants born at 24-26 weeks' gestation, with severe disability below 10%.

Conclusions:

• Perinatal centers and strategies like 'in utero transfer' significantly improve outcomes for extremely preterm infants.
• Advanced therapies such as surfactant and mechanical ventilation, despite costs, improve quality-adjusted life-years gained.
• Population-based studies are essential for understanding the broader impact of perinatal care initiatives.