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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Extremely low birthweight neonates with protracted ventilation: mortality and 18-month neurodevelopmental outcomes
Michele C Walsh1, Brenda H Morris, Lisa A Wrage
1Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA. mcw3@po.cwru.edu
Insights
Prolonged mechanical ventilation for extremely low birth weight (ELBW) infants is associated with poor survival and high rates of neurodevelopmental impairment. Prognosis worsens significantly with increased ventilation duration, requiring informed parental counseling.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Perinatal Medicine
Background:
- Extremely low birth weight (ELBW) infants often require mechanical ventilation.
- Understanding the impact of ventilation duration on outcomes is crucial for clinical decision-making.
Purpose of the Study:
- To compare the duration of mechanical ventilation with mortality and adverse neurodevelopmental outcomes in ELBW infants.
Main Methods:
- Retrospective analysis of prospectively collected data from 5364 ELBW infants (501-1000 g).
- Data collected from National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers (1995-1998).
- Primary outcomes included survival, duration of mechanical ventilation, and neurodevelopmental status.
Main Results:
- Overall survival rate was 71%.
- Median ventilation duration for survivors was 23 days; 75% extubated by 39 days.
- Ventilation for ≥60 days resulted in 24% survival without impairment; ≥90 days had 7% survival without impairment; ≥120 days had all survivors impaired.
Conclusions:
- Protracted mechanical ventilation in ELBW infants is linked to grim prognoses.
- Prolonged intubation significantly diminishes survival and increases impairment rates.
- Parents must be informed about the changing prognosis as ventilation time increases.
Objective:
To compare duration of ventilation to mortality and adverse neurodevelopmental outcomes among extremely low birth weight (ELBW; 501-1000 g) infants.
Study Design:
Retrospective analysis of prospectively collected data from 5364 infants with a birthweight of 501 to 1000 g born at National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers from 1995 to 1998. The main outcome measures were: survival, duration of mechanical ventilation, and neurodevelopmental outcome.
Results:
Overall survival was 71%. The median duration of ventilation for survivors was 23 days; 75% were free of mechanical ventilation by 39 days, and 7% were ventilated for > or = 60 days. Of those ventilated for > or = 60 days, 24% survived without impairment. Of those ventilated for > or = 90 days, only 7% survived without impairment. Of those ventilated > or = 120 days, all survivors were impaired.
Conclusions:
The prognosis for ELBW with protracted ventilation remains grim. The cohort who remain intubated have diminished survival and high rates of impairment. Parents of these infants should be informed of changes in prognosis as the time of ventilation increases.
