Survival and neurodevelopmental outcomes among periviable infants

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Abstract

BACKGROUND Data reported during the past 5 years indicate that rates of survival have increased among infants born at the borderline of viability, but less is known about how increased rates of survival among these infants relate to early childhood neurodevelopmental outcomes. METHODS We compared survival and neurodevelopmental outcomes among infants born at 22 to 24 weeks of gestation, as assessed at 18 to 22 months of corrected age, across three consecutive birth-year epochs (2000-2003 [epoch 1], 2004-2007 [epoch 2], and 2008- 2011 [epoch 3]). The infants were born at 11 centers that participated in the National Institute of Child Health and Human Development Neonatal Research Network. The primary outcome measure was a three-level outcome - survival without neurodevelopmental impairment, survival with neurodevelopmental impairment, or death. After accounting for differences in infant characteristics, including birth center, we used multinomial generalized logit models to compare the relative risk of survival without neurodevelopmental impairment, survival with neurodevelopmental impairment, and death. RESULTS Data on the primary outcome were available for 4274 of 4458 infants (96%) born at the 11 centers. The percentage of infants who survived increased from 30% (424 of 1391 infants) in epoch 1 to 36% (487 of 1348 infants) in epoch 3 (P<0.001). The percentage of infants who survived without neurodevelopmental impairment increased from 16% (217 of 1391) in epoch 1 to 20% (276 of 1348) in epoch 3 (P = 0.001), whereas the percentage of infants who survived with neurodevelopmental impairment did not change significantly (15% [207 of 1391] in epoch 1 and 16% [211 of 1348] in epoch 3, P = 0.29). After adjustment for changes in the baseline characteristics of the infants over time, both the rate of survival with neurodevelopmental impairment (as compared with death) and the rate of survival without neurodevelopmental impairment (as compared with death) increased over time (adjusted relative risks, 1.27 [95% confidence interval {CI}, 1.01 to 1.59] and 1.59 [95% CI, 1.28 to 1.99], respectively). CONCLUSIONS The rate of survival without neurodevelopmental impairment increased between 2000 and 2011 in this large cohort of periviable infants.

Original languageEnglish
Pages (from-to)617-628
Number of pages12
JournalNew England Journal of Medicine
Volume376
Issue number7
DOIs
StatePublished - Feb 16 2017

Bibliographical note

Funding Information:
Supported by grants from the National Institutes of Health (including grants 5T32HD043728-10, HD060558-05, and 4K12HD043494-14 to Dr. Younge) and from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, grants from the National Center for Research Resources, and cooperative agreements from the National Center for Advancing Translational Sciences for the Neonatal Research Network's Generic Database and Follow-up Studies (U10 HD27904, U10 HD21364, M01 RR80, U10 HD68284, U10 HD27853, M01 RR8084, U10 HD40492, M01 RR30, U10 HD27851, M01 RR39, U10 HD27856, M01 RR750, U10 HD68278, U10 HD36790, U10 HD27880, M01 RR70, UL1 TR93, U10 HD53119, M01 RR54, U10 HD34216, M01 RR32, U10 HD68270, U10 HD40461, U10 HD53109, M01 RR59, U10 HD21397, M01 RR16587, U10 HD27881, U10 HD53089, M01 RR997, U10 HD68244, U10 HD68263, U10 HD40521, UL1 RR24160, M01 RR44, UL1 TR42, U10 HD21415, U10 HD21373, U10 HD40689, M01 RR633, U10 HD53124, M01 RR64, UL1 TR105, U10 HD40498, M01 RR7122, U10 HD21385, U10 HD27871, UL1 RR24139, M01 RR125, and UL1 TR142).

Publisher Copyright:
© 2017 Massachusetts Medical Society.

ASJC Scopus subject areas

  • Medicine (all)

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