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Neonatal Intensive Care Unit Outcomes and Resource Use Among Extremely Preterm Survivors
Temesgen Getaneh1,2, Nusrat Homaira1,3,4, Prudence Creighton5
1Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW, Randwick, Sydney, Australia.
Acta Paediatrica (Oslo, Norway : 1992)
|October 18, 2025
Summary
Survival for extremely preterm infants improved, but major morbidities like bronchopulmonary dysplasia and retinopathy of prematurity also increased. These infants required more intensive neonatal care.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Extremely preterm (EPT) infants (born at 22-27 weeks gestation) represent a vulnerable population requiring specialized neonatal intensive care (NICU).
- Understanding survival trends and associated morbidities in EPT infants is crucial for improving outcomes and resource allocation in NICUs.
Purpose of the Study:
- To evaluate survival outcomes and neonatal intensive care unit (NICU) utilization among extremely preterm infants in Australia and New Zealand.
- To analyze trends in major morbidities, including bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), over a five-year period.
Main Methods:
- A retrospective analysis of prospectively collected data from the Australian and New Zealand Neonatal Network.
- Inclusion criteria: infants born at 22-27 weeks gestation, admitted to 29 NICUs between January 2018 and December 2022.
- Data collected included survival rates, major morbidities, antenatal steroid use, and intensive care interventions.
Main Results:
- Overall survival for 5414 EPT infants was 83.1%, with 63.7% surviving without major morbidities.
- Survival rates increased from 40.2% in 2018 to 51.9% in 2022 for infants born at 22-23 weeks gestation.
- Survival with major morbidities increased significantly from 33.9% to 39.1% (p=0.013), driven by higher rates of BPD (17.4% to 21.2%) and ROP (14.5% to 17.7%).
- Infants with major morbidities experienced longer mechanical ventilation and parenteral nutrition durations.
Conclusions:
- While overall survival for extremely preterm infants has improved, there has been a concerning rise in major morbidities, specifically BPD and ROP.
- These infants with major morbidities necessitate more intensive and prolonged NICU care.
- Continued research and clinical advancements are needed to mitigate morbidities while optimizing survival in this high-risk population.
