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Outcomes for extremely premature infants.

Hannah C Glass1, Andrew T Costarino, Stephen A Stayer

  • 1From the *Department of Neurology and Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California; †Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; ‡Department of Pediatric Anesthesiology, The Alfred I. duPont Hospital for Children, Wilmington, Delaware; §Baylor College of Medicine, Texas Children's Hospital, Houston, Texas; ∥Department of Anesthesiology and Perioperative Care, University of California, San Francisco, San Francisco, California; and ¶Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Anesthesia and Analgesia
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Extremely premature infants face high risks of death and disability. Advances in neonatal care, including respiratory support and antenatal steroids, have improved survival, but long-term outcomes require ongoing research and follow-up.

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Area of Science:

  • Neonatalogy
  • Perinatology
  • Pediatric Critical Care

Background:

  • Premature birth remains a leading cause of infant mortality and morbidity.
  • Despite a recent decline in the US, the premature birth rate is approximately 11.39%, with human viability around 23-24 weeks gestation.
  • Extremely premature infants (<28 weeks gestation) and extremely low birth weight infants (<1000 g) face significant mortality (30-50%) and morbidity (20-50%) risks.

Purpose of the Study:

  • To review the advancements in neonatal intensive care for extremely premature infants.
  • To highlight the persistent challenges and evolving strategies in managing extremely low birth weight infants.
  • To emphasize the critical need for long-term follow-up and novel interventions.

Main Methods:

  • Review of historical and recent advancements in neonatal care, including respiratory support, surfactant therapy, antenatal steroids, and oxygen saturation targets.
  • Discussion of the impact of neonatal intensive care units and neurocritical care on outcomes.
  • Examination of ongoing research into antioxidant and anti-inflammatory pathways.

Main Results:

  • Introduction of continuous positive airway pressure, mechanical ventilation, and exogenous surfactant in the 1970s-1990s improved survival.
  • Routine antenatal steroids in the late 1990s reduced neonatal mortality and morbidity.
  • Current research on oxygen saturation targets (91-95%) may further improve outcomes, pending final data analysis.

Conclusions:

  • Neonatal intensive care has significantly improved survival rates for premature infants.
  • Extremely premature infants continue to require specialized care and long-term developmental monitoring.
  • Future research focusing on organ protection, growth preservation, and anti-inflammatory/antioxidant strategies is crucial for improving long-term outcomes.