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The NICHD neonatal research network: changes in practice and outcomes during the first 15 years
Avroy A Fanaroff1, Maureen Hack, Michele C Walsh
1Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH, USA. aaf2@cwru.edu
Seminars in Perinatology
|September 27, 2003
Summary
Neonatal Research Network trials show improved survival for low birth weight infants. Advances in perinatal care reduced mortality, but survival free of major morbidity remains a challenge.
Area of Science:
- Neonatal research and perinatal medicine.
- Clinical trials and network collaboration.
- Infant health outcomes and survival rates.
Background:
- The National Institute of Child Health and Human Development (NICHD) Neonatal Research Network was established in 1986 to conduct large-scale, multi-center clinical trials.
- The Network registry collects perinatal and neonatal data for infants with birth weights between 501 and 1500 grams.
- This report analyzes changes in mortality, morbidity, and therapies across three distinct time periods: 1987/1988, 1993/1994, and 1999/2000.
Purpose of the Study:
- To document changes in mortality, selected morbidities, and therapeutic interventions within NICHD Neonatal Research Network centers over time.
- To compare outcomes for infants across different birth weight categories and gestational ages during specified periods.
- To assess the impact of advancements in perinatal care, including surfactant therapy and antenatal corticosteroid use, on infant survival and morbidity.
Main Methods:
- Retrospective analysis of data from the NICHD Neonatal Research Network registry.
- Comparison of mortality and morbidity rates for infants with birth weights 501-1500g across three time periods (pre-surfactant, post-surfactant/moderate antenatal corticosteroids, post-surfactant/widespread antenatal corticosteroids).
- Detailed examination of outcomes for extremely low birth weight infants (501-800g) and those with gestational ages of 23-25 weeks.
Main Results:
- Overall mortality decreased from 23% in 1987/1988 to 14% in 1999/2000.
- Significant reductions in mortality were observed across all birth weight strata, with the largest decrease for infants weighing 751-1000g (34% to 12%).
- While survival improved, survival free of major morbidities (chronic lung disease, necrotizing enterocolitis, severe intraventricular hemorrhage) did not change significantly; however, rates of grade III-IV intraventricular hemorrhage and periventricular leukomalacia decreased.
Conclusions:
- Advances in perinatal care within the NICHD Neonatal Research Network have led to substantial improvements in survival rates for low birth weight infants.
- Therapeutic interventions such as surfactant administration and antenatal corticosteroid use have played a crucial role in these survival gains.
- Further research and clinical advancements are necessary to improve survival rates that are free from neonatal morbidity and potential neurodevelopmental impairments.