Outcomes at 18 to 22 Months of Corrected Age for Infants Born at 22 to 25 Weeks of Gestation in a Center Practicing
Patricia L Watkins1, John M Dagle1, Edward F Bell1
1Division of Neonatology, Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA.
Insights
Actively managed extremely preterm infants born at 22-25 weeks gestation show positive neurodevelopmental outcomes. Most survivors had no or mild impairment, indicating successful neonatal intensive care unit (NICU) management.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Perinatal Research
Background:
- Extremely preterm infants born between 22-25 weeks gestation represent a vulnerable population requiring intensive care.
- Assessing neurodevelopmental outcomes is crucial for understanding the long-term impact of neonatal intensive care unit (NICU) interventions.
Purpose of the Study:
- To evaluate the neurodevelopmental outcomes of extremely preterm infants managed actively following admission to a neonatal intensive care unit (NICU).
Main Methods:
- A retrospective cohort study included 255 infants born at 22-25 weeks gestation (2006-2015).
- Neurodevelopmental outcomes were assessed at 18-22 months corrected age in 169 survivors using the Bayley Scales of Infant-Toddler Development (3rd edition).
- Statistical analyses included Mann-Whitney U, chi-squared, and generalized estimating equations.
Main Results:
- Survival to hospital discharge was 78% for infants born at 22-23 weeks and 89% for those born at 24-25 weeks (P=.02).
- No or mild neurodevelopmental impairment was observed in 64% of survivors born at 22-23 weeks and 76% born at 24-25 weeks (P=.16).
Conclusions:
- Despite lower survival rates at 22-23 weeks gestation, the majority of extremely preterm infants who survive NICU admission experience positive neurodevelopmental outcomes.
- These findings support active management strategies for extremely preterm infants, though further research on school-age performance is recommended.
Objective:
To assess the outcomes in actively managed extremely preterm infants after admission to a neonatal intensive care unit.
Study Design:
Retrospective cohort of 255 infants born at 22-25 weeks of gestation between 2006 and 2015 at a single study institution. Infants were excluded for congenital anomaly, death in delivery room, or parental request for palliation (n = 7). Neurodevelopmental outcomes were analyzed for 169 of 214 survivors (78.9%) at 18-22 months of corrected age. Outcomes were evaluated using the Mann-Whitney U, χ2, or Fisher exact test, where appropriate. In addition, cognitive scores of the Bayley Scales of Infant-Toddler Development (3rd edition) were assessed using generalized estimating equations.
Results:
Seventy infants born at 22-23 weeks of gestation (22 weeks, n = 20; 23 weeks, n = 50) and 178 infants born at 24-25 weeks of gestation (24 weeks, n = 79; 25 weeks, n = 99 infants) were included. Survival to hospital discharge of those surviving to NICU admission was 78% (55/70; 95% CI, 69%-88%) at 22-23 weeks and 89% (159/178; 95% CI, 84%-93% at 24-25 weeks; P = .02). No or mild neurodevelopmental impairment in surviving infants was 64% (29/45; 95% CI, 50%-77%) at 22-23 weeks and 76% (94/124; 95% CI, 68%-83%; P = .16) at 24-25 weeks.
Conclusions:
Although survival was lower in infants born at 22-23 weeks than at 24-25 weeks of gestation, the majority of survivors in both groups had positive outcomes with no or mild neurodevelopmental impairments. Further evaluation of school performance is warranted.
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