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Published on: January 7, 2018
Survival, morbidity, and resource use of infants of 25 weeks' gestational age or less
1Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
Insights
Extremely preterm infants born at 22-25 weeks gestation have a 63% survival rate, but face significant mortality and morbidity risks. These infants consume a disproportionate share of neonatal intensive care unit resources.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Extremely preterm infants (born at or before 25 weeks gestation) represent a vulnerable population with unique healthcare needs.
- Understanding their survival, morbidity, and resource utilization is crucial for optimizing neonatal intensive care.
Purpose of the Study:
- To analyze survival rates, common morbidities, and resource consumption in a large cohort of extremely preterm infants.
- To compare outcomes between inborn and outborn infants within this population.
Main Methods:
- Retrospective analysis of 754 neonatal intensive care unit admissions and 949 inborn deliveries between 22 and 25 weeks gestation.
- Data collected from 17 Canadian neonatal intensive care units.
Main Results:
- Overall survival was 63%, varying from 14% at 22 weeks to 76% at 25 weeks gestation.
- High rates of chronic lung disease (33-51%), severe intraventricular hemorrhage (0-16%), necrotizing enterocolitis (0-14%), retinopathy of prematurity (27-55%), and nosocomial infections (25-39%) were observed.
- Despite comprising 4% of admissions, these infants accounted for 22% of deaths and significant morbidity and resource use.
Conclusions:
- Extremely preterm infants experience high mortality and morbidity.
- This population places a substantial burden on neonatal intensive care unit resources, necessitating targeted interventions and resource allocation.
Objective:
The objective of this study was to examine survival, morbidity, and resource use in a large cohort of extremely preterm infants.
Study Design:
We examined all (n = 754) neonatal intensive care unit admissions born at < or =25 weeks' gestation and inborn deliveries (n = 949) between 22 and 25 weeks' gestation at 17 Canadian neonatal intensive care units.
Results:
The overall survival rate was 63%, with a range from 14% at 22 weeks' gestation to 76% at 25 weeks' gestation. There was a high incidence of chronic lung disease (33%-51%), > or =grade 3 intraventricular hemorrhage (0%-16%), necrotizing enterocolitis (0%-14%), > or =stage 3 retinopathy of prematurity (27%-55%), nosocomial infection (25%-39%), and multiple gestation (18%-46%). Extremely preterm infants comprise 4% of neonatal intensive care unit admissions but account for 22% of deaths, 20%-60% of major morbidities, 11% of patient days, and 10%-35% of major procedures. Outborn infants had a higher incidence of chronic lung disease, severe retinopathy of prematurity, and intraventricular hemorrhage.
Conclusion:
Extremely preterm infants have a high incidence of mortality and morbidity and consume disproportionate amounts of neonatal intensive care unit resources.