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Apnoea of immaturity. 2. Mortality and handicap
Insights
Early treatment for recurrent apnea of prematurity in infants under 32 weeks gestation may improve survival rates. Delayed treatment increased the need for mechanical ventilation and mortality, with some survivors experiencing major handicaps.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Perinatology
Background:
- Recurrent apnoea of immaturity is common in preterm infants.
- Apnoea with bradycardia can lead to significant morbidity and mortality.
- Optimal timing for intervention in preterm infants with apnoea remains debated.
Purpose of the Study:
- To assess survival rates in preterm infants based on the timing of treatment for recurrent apnoea of immaturity.
- To evaluate the impact of delayed treatment versus early intervention on outcomes.
- To identify potential long-term handicaps in survivors.
Main Methods:
- Retrospective review of 103 infants born at or before 32 weeks' gestation with recurrent apnoea.
- Categorization of infants based on the timing of treatment initiation for apnoea with bradycardia.
- Assessment of mortality, need for mechanical ventilation, and long-term developmental outcomes in survivors.
Main Results:
- Infants treated after 1-3 episodes of apnoea with bradycardia had a 70% mortality rate.
- Delayed treatment for mild apnoea resulted in 34% requiring mechanical ventilation and 23% mortality.
- Among 20 survivors assessed at 9-24 months, 20% had major handicaps.
Conclusions:
- The timing of treatment for apnoea of immaturity significantly impacts survival and morbidity in preterm infants.
- Earlier intervention may be warranted to reduce mortality and the need for mechanical ventilation.
- Long-term neurodevelopmental follow-up is crucial for survivors of significant apnoeic events.
Abstract:
One hundred and three consecutive infants less than or equal to 32 weeks' gestation with recurrent apnoea of immaturity were reviewed, and survival was assessed and related to timing of treatment. The sickest infants were treated after between one and three episodes of apnoea with bradycardia, and mortality was 70%. Of those in whom treatment was postponed because apnoea was considered mild, 34% subsequently required mechanical ventilation, and 23% died. Among a small group of 20 survivors seen at ages 9-24 months, 4 (20%) have major handicaps. The possible place for earlier treatment is discussed.