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Cited by 2,791Infant Development and Preterm CareNeonatal Respiratory Health ResearchNeonatal and fetal brain pathology

Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993-2012

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Stoll, Barbara J., Hansen, Nellie I., Bell, Edward F., Walsh, Michele C., Carlo, Waldemar A., Shankaran, Seetha, Laptook, Abbot R., Sánchez, Pablo J. +16 more·2015·JAMA
DOI 10.1001/jama.2015.10244PMC PMC4787615
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Abstract

IMPORTANCE: Extremely preterm infants contribute disproportionately to neonatal morbidity and mortality. OBJECTIVE: To review 20-year trends in maternal/neonatal care, complications, and mortality among extremely preterm infants born at Neonatal Research Network centers. DESIGN, SETTING, PARTICIPANTS: Prospective registry of 34,636 infants, 22 to 28 weeks' gestation, birth weight of 401 to 1500 g, and born at 26 network centers between 1993 and 2012. EXPOSURES: Extremely preterm birth. MAIN OUTCOMES AND MEASURES: Maternal/neonatal care, morbidities, and survival. Major morbidities, reported for infants who survived more than 12 hours, were severe necrotizing enterocolitis, infection, bronchopulmonary dysplasia, severe intracranial hemorrhage, cystic periventricular leukomalacia, and/or severe retinopathy of prematurity. Regression models assessed yearly changes and were adjusted for study center, race/ethnicity, gestational age, birth weight for gestational age, and sex. RESULTS: Use of antenatal corticosteroids increased from 1993 to 2012 (24% [348 of 1431 infants]) to 87% (1674 of 1919 infants]; P < .001), as did cesarean delivery (44% [625 of 1431 births] to 64% [1227 of 1921]; P < .001). Delivery room intubation decreased from 80% (1144 of 1433 infants) in 1993 to 65% (1253 of 1922) in 2012 (P < .001). After increasing in the 1990s, postnatal steroid use declined to 8% (141 of 1757 infants) in 2004 (P < .001), with no significant change thereafter. Although most infants were ventilated, continuous positive airway pressure without ventilation increased from 7% (120 of 1666 infants) in 2002 to 11% (190 of 1756 infants) in 2012 (P < .001). Despite no improvement from 1993 to 2004, rates of late-onset sepsis declined between 2005 and 2012 for infants of each gestational age (median, 26 weeks [37% {109 of 296} to 27% {85 of 320}]; adjusted relative risk [RR], 0.93 [95% CI, 0.92-0.94]). Rates of other morbidities declined, but bronchopulmonary dysplasia increased between 2009 and 2012 for infants at 26 to 27 weeks' gestation (26 weeks, 50% [130 of 258] to 55% [164 of 297]; P < .001). Survival increased between 2009 and 2012 for infants at 23 weeks' gestation (27% [41 of 152] to 33% [50 of 150]; adjusted RR, 1.09 [95% CI, 1.05-1.14]) and 24 weeks (63% [156 of 248] to 65% [174 of 269]; adjusted RR, 1.05 [95% CI, 1.03-1.07]), with smaller relative increases for infants at 25 and 27 weeks' gestation, and no change for infants at 22, 26, and 28 weeks' gestation. Survival without major morbidity increased approximately 2% per year for infants at 25 to 28 weeks' gestation, with no change for infants at 22 to 24 weeks' gestation. CONCLUSIONS AND RELEVANCE: Among extremely preterm infants born at US academic centers over the last 20 years, changes in maternal and infant care practices and modest reductions in several morbidities were observed, although bronchopulmonary dysplasia increased. Survival increased most markedly for infants born at 23 and 24 weeks' gestation and survival without major morbidity increased for infants aged 25 to 28 weeks. These findings may be valuable in counseling families and developing novel interventions. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00063063.

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  • Fetal lung maturity assessment critically influences the incidence of respiratory distress syndrome (RDS), which accounts for approximately 20% of preterm neonatal deaths.

    “Fetal lung maturity (FLM) assessment is a cornerstone of neonatal care, critically influencing the incidence of respiratory distress syndrome (RDS), which accounts for approximately 20% of preterm neonatal deaths (1).”

    From Placenta-pulmonary coupling-guided multimodal AI for fetal lung maturity staging and individualized glucocorticoid therapy (2026) · cites this paper as [1]

    The Methods > Outcomes and Results > Care practices passages describe neonatal outcomes and respiratory treatments, but do not address fetal lung maturity assessment. Searches for lung maturity, respiratory distress syndrome, and respiratory causes of death found no passage supporting the claimed effect on RDS or the approximately 20% mortality figure; page numbers were not provided in our copy. (LLM, conf=0.76)

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Research works printed but not linked: 43

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Authors
Stoll, B. J., Hansen, N. I., Bell, E. F., Walsh, M. C., Carlo, W. A., Shankaran, S., Laptook, A. R., Sánchez, P. J., Van Meurs, K. P., Wyckoff, M., Das, A., Hale, E. C., Ball, M. B., Newman, N. S., Schibler, K., Poindexter, B. B., Kennedy, K. A., Cotten, C. M., Watterberg, K. L., D’Angio, C. T., DeMauro, S. B., Truog, W. E., Devaskar, U., & Higgins, R. D.
Affiliations
  • Emory University (US)
  • RTI International (US)
  • University of Iowa (US)
  • Rainbow Babies & Children's Hospital (US)
  • University of Alabama at Birmingham (US)
  • Wayne State University (US)
  • Brown University (US)
  • Nationwide Children's Hospital (US)
  • Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California10Lucile Packard Children's Hospital, Palo Alto, California
  • The University of Texas Southwestern Medical Center (US)
  • Lucile Packard Children's Hospital (US)
  • Cincinnati Children's Hospital Medical Center (US)
  • Indiana University Indianapolis (US)
  • The University of Texas Health Science Center at Houston (US)
  • Duke University (US)
  • University of New Mexico Health Sciences Center (US)
  • University of Rochester Medicine (US)
  • University of Pennsylvania (US)
  • Children's Mercy Hospital (US)
  • University of California, Los Angeles (US)
  • National Institutes of Health (US)
Corresponding author
Stoll, Barbara J.
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2015-09-08
Volume
314
Issue
10
Pages
1039
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2015.10244
PMC
PMC4787615
OpenAlex
W1857797615
Cited by
2,791
References
1
Citations by year
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FWCI
167.10
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • UNM’s Digital Repository (University of New Mexico) (submittedVersion)
Funders
  • National Institutes of Health (UL1TR000041, UL1TR001117, UL1TR001449, UL1TR001111, UL1TR001425)
  • National Center for Research Resources (M01-RR-32, M01RR008084, M01RR016587, M01-RR-80, M01RR6022, M01RR006022, M01 RR997, M01‐RR16587, M01 RR39, M01 RR 750, M01 RR64, M01RR54, M01 RR 30, M01 RR633, M01RR8084, M01 RR70, M01RR007122, M01RR7122, M01 RR44, M01-RR59)
  • National Center for Advancing Translational Sciences (UL1 TR442, UL1 TR41, UL1 TR105, UL1 TR142, UL1 TR42, UL1 TR93, UL1 TR1111, UL1 TR77, UL1 TR454, UL1 TR1117, UL1 TR6)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10HD040498, (U10 HD27871, U10 HD 36790, U10 HD 27853, U10HD027880, U10 HD27880, U10 HD 40461, U10HD40521, U10HD21385, U10HD 21397, U10HD40498, U10HD27851, U10 HD34216, U10HD40492, U10-HD-21415, U10‐HD‐27904, U10HD068284, U10 HD27881, U10 HD68278, U10 HD53124, U10HD068244, U10HD021397, U10HD027904, U10 HD21364, U10HD027856, U10HD040689, U10HD027871, U10-HD21373, U10HD027853, UG1HD068284, U10HD040492, U10HD027881, U10HD021364, U10HD034216, U10 HD68244, U10 HD53089, UG1HD021385, U10HD068278, U10HD053119, U10HD021415, U10HD021373, U10HD53119, U10HD036790, U10HD021385, U10 HD68263, U10 HD68284, U10HD40689, U10HD034167, U10HD053109, U10HD53109, U10HD053124, U10 HD68270, U10HD053089, UG1HD087229, U10HD068263, U10 HD27856, U10HD040521, U10HD027851, U10HD040461, UG1HD034216, UG1HD027880, UG1HD021364, UG1HD053089, UG1HD053109, U10HD068270)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
Keywords
extremely preterm infants, neonatal morbidity, neonatal mortality, antenatal corticosteroids, cesarean section, delivery room intubation, postnatal corticosteroids, mechanical ventilation, continuous positive airway pressure, bronchopulmonary dysplasia, necrotizing enterocolitis, intracranial hemorrhage, periventricular leukomalacia, retinopathy of prematurity, survival
MeSH terms
Adrenal Cortex Hormones, Adult, Bronchopulmonary Dysplasia, Cesarean Section, Female, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases, Infections, Leukomalacia, Periventricular, Male, Pregnancy, Retinopathy of Prematurity, United States, Intensive Care, Neonatal, Survival Analysis, Intracranial Hemorrhages, Enterocolitis, Necrotizing, Continuous Positive Airway Pressure, Infant, Extremely Premature

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