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Updated: May 7, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Trends and Contributing Factors Affecting Survival and Neurodevelopmental Outcomes in Infants Born at ≤25 Weeks'
Kalsang Dolma1, Diksha Shrestha1, Ramachandra Bhat1
1Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama, United States.
Insights
Survival rates for extremely preterm infants have plateaued, but pulmonary and neurodevelopmental morbidities have increased, indicating a need for improved care strategies, especially oxygen management.
Area of Science:
- Neonatal Intensive Care
- Perinatal Medicine
- Developmental Pediatrics
Background:
- Previous data showed declining mortality for infants born at 22 weeks' gestation (1998-2008).
- Neurodevelopmental impairment decreased in infants born at 23-24 weeks' gestation during the same period.
- Understanding trends in periviable infants (≤25 weeks' gestation) is crucial for optimizing care.
Purpose of the Study:
- To analyze temporal trends in survival and neurodevelopmental outcomes for periviable infants (≤25 weeks' gestation) from 2009 to 2020.
- To identify clinical and perinatal factors associated with outcomes in this vulnerable population.
- To evaluate the impact of clinical practice changes on infant outcomes.
Main Methods:
- Retrospective cohort study at a single level III neonatal intensive care unit.
- Infants born at ≤25 weeks' gestation were divided into two epochs: 2009-2014 and 2015-2020.
- Comparison of survival, major in-hospital morbidities, and neurodevelopmental outcomes at 2 years' corrected age.
Main Results:
- Survival rates remained stable between epochs (76% vs. 78%).
- Significant increases in bronchopulmonary dysplasia (41% vs. 57%) and oxygen use at discharge (23% vs. 47%) were observed in the later epoch.
- Severe neurodevelopmental impairment doubled (19% vs. 38%), and 2-year follow-up rates declined markedly (75% vs. 40%).
- Higher oxygen saturation targets were associated with increased pulmonary and neurodevelopmental morbidity.
Conclusions:
- While survival rates for periviable infants have plateaued, there is a concerning rise in pulmonary and neurodevelopmental morbidities.
- Evolving clinical practices, particularly oxygen management, may contribute to these adverse outcomes.
- Improved care strategies and enhanced long-term monitoring are essential for this high-risk population.
Objective:
Previous data from our institution demonstrated a decline in mortality among infants born at 22 weeks' gestation from 1998 to 2008, alongside a reduction in neurodevelopmental impairment in infants born at 23 to 24 weeks' gestation. This study aimed to analyze temporal trends and identify clinical and perinatal factors associated with survival and neurodevelopmental outcomes in periviable infants (gestational age ≤25 weeks) born between 2009 and 2020.
Study Design:
This retrospective cohort study was conducted at a single level III neonatal intensive care unit. Infants born at ≤25 weeks' gestation were grouped into two epochs: 2009 to 2014 and 2015 to 2020. Survival, major in-hospital morbidities, and neurodevelopmental outcomes at 2 years' corrected age were compared. Clinical practice changes during the study period were evaluated as potential contributors to variations in outcome.
Results:
A total of 672 infants were included (Epoch 1 [E1]: n = 316; Epoch 2 [E2]: n = 356) during the study period. Survival rates were similar between epochs (E1 vs. E2; 76 vs. 78%; p = 0.42). However, rates of grade 2 or 3 bronchopulmonary dysplasia (41 vs. 57%; p < 0.01) and oxygen use at discharge (23 vs. 47%; p < 0.01) increased significantly in Epoch 2. The prevalence of severe neurodevelopmental impairment also rose substantially (19 vs. 38%; p < 0.01). Follow-up at 2 years declined markedly in Epoch 2 (75 vs. 40%; p < 0.01), limiting confidence in long-term outcome estimates. Notably, a shift in clinical practice toward higher oxygen saturation targets was associated with this increase in pulmonary and neurodevelopmental morbidity.
Conclusion:
Although survival rates for infants born at ≤25 weeks' gestation have stabilized, the concurrent rise in pulmonary and neurodevelopmental morbidities signals the need for improved care strategies, particularly oxygen management, and emphasizes the importance of long-term monitoring for this vulnerable population.
Key Points:
· Survival rates at ≤25 weeks have plateaued at our single center over the past decade.. · Pulmonary morbidities have increased, likely influenced by evolving care practices.. · Neurodevelopmental outcomes are worsening, highlighting the need to improve intact survival..
