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Published on: November 20, 2015
In-hospital morbidity and brain metrics of preterm neonates born 1998-2009
Sarah L Harris1, Nicola C Austin2, Malcolm Battin3
1Neonatologist, Neonatal Service, Christchurch Women's Hospital, Department of Pediatrics, University of Otago, Christchurch.
Insights
Improved clinical care for extremely preterm infants led to better growth and brain development, with enhanced neurodevelopmental outcomes at two years. Survival rates remained stable, highlighting advancements in neonatal intensive care.
Area of Science:
- Neonatal Medicine
- Perinatology
- Developmental Pediatrics
Background:
- Extremely preterm infants (<28 weeks gestation) face significant risks for morbidity and long-term neurodevelopmental challenges.
- Changes in clinical practice may influence outcomes for this vulnerable population.
Purpose of the Study:
- To compare survival, in-hospital morbidity, brain metrics, and two-year neurodevelopmental outcomes between two extremely preterm cohorts.
- To assess the impact of evolving clinical practices on these outcomes.
Main Methods:
- Retrospective comparative cohort study of two groups of neonates born before 28 weeks gestation.
- Cohorts represent infants born between 1998-2000 and 2006-2009.
Main Results:
- The contemporary cohort showed improved physiological stability (higher admission temperature, lower CRIB score) and reduced need for inotrope support and high-frequency ventilation.
- Significant reductions in chronic lung disease, retinopathy of prematurity (ROP), and red cell transfusions were observed in the later cohort.
- Improved nutritional intake, enhanced weight gain by 36 weeks corrected age, better brain metrics (bifrontal, biparietal, transcerebellar diameters), and improved two-year neurodevelopmental outcomes were noted.
Conclusions:
- The contemporary cohort demonstrated enhanced physiological stability, reduced morbidities (CLD, ROP), improved growth, and better brain development.
- Improvements in neurodevelopmental outcomes at two years suggest a positive impact of changes in clinical care for extremely preterm infants.
Aims:
To describe the survival, in-hospital morbidity, brain metrics and two-year neurodevelopmental outcomes of two extremely preterm cohorts and discuss the contribution of changes in clinical practice to these outcomes.
Methods:
Retrospective comparative cohort study, of two cohorts of neonates born <28 weeks gestation: 47 infants born 1998-2000 and 39 infants 2006-2009.
Results:
Comparing historical to the contemporary cohort respectively, admission temperature (35.9 degrees C, 36.5) and CRIB (Clinical Risk Index in Babies) score (5.4, 3.1) improved. Inotrope support fell significantly (55.3%, 28.2%). High frequency ventilation days fell (8.0, 2.7). CPAP days increased significantly (32.2, 47.9). Chronic lung disease at 36 weeks corrected age fell significantly (61.7%, 38.5%). Red cell transfusions decreased in number (7.1, 4.8) and volume (96.2ml/kg, 70.4ml/kg). Retinopathy of prematurity (ROP) rates dropped significantly (66.0%, 28.2%). Survival was not significantly different. Nutritional improvements included shorter days to first enteral feed (3.4, 2.0), target protein (5.4, 4.3) and lipid levels (7.1, 4.1) with better breastfeeding rates at discharge (19.2%, 38.5%). By 36 weeks z scores for weight (-0.90, -0.39) were improved but not length (-1.94, -1.26) or head circumference (-0.72, -0.69). MRI brain metrics showed a significant improvement in bifrontal (59.2, 65.9), biparietal (73.7, 79.3) and transcerebellar diameter (50.6, 52.6) with improved neurodevelopmental outcome at two years.
Conclusion:
The contemporary cohort had better initial physiological stability, less chronic lung disease and retinopathy, improved body growth at 36 weeks and brain metrics at term equivalent. Improvement in neurodevelopment at two years has been seen and further analysis will be important to understand the impact of the changes in clinical care.
