Changes in mortality and morbidities among infants born at less than 25 weeks during the post-surfactant era

S. R. Hintz, W. K. Poole, L. L. Wright, A. A. Fanaroff, D. E. Kendrick, A. R. Laptook, R. Goldberg, Shahnaz Duara, B. J. Stoll, W. Oh

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Abstract

Objectives: To compare mortality and death or major morbidity (DOMM) among infants <25 weeks estimated gestational age (EGA) born during two post-surfactant era time periods. Study design and patients: Comparative cohort study of very low birthweight (501-1500 g) infants <25 weeks EGA in the NICHD Neonatal Research Network born during two post-surfactant era time periods (group I, 1991-1994, n = 1408; group II, 1995-1998, n = 1348). Perinatal and neonatal factors were compared, and group related mortality and DOMM risk were evaluated. Results: Mortality was higher for group I (63.1% v 56.7%; p = 0.0006). Antenatal steroids (ANS) and antenatal antibiotics (AABX), surfactant (p<0.0001), and bronchopulmonary dysplasia (p = 0.0008) were more prevalent in group II. In a regression model that controlled for basic and delivery factors only, mortality risk was greater for group I than for group II (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2 to 1.7); the addition of AABX and surfactant, or ANS (OR 0.97, 95% CI 0.79 to 1.2) to the model appeared to account for this difference. There was no difference in DOMM (86.8% v 88.4%; p = 0.2), but risk was lower for group I in regression models that included ANS (OR 0.70, 95% CI 0.52 to 0.94). Conclusion: Survival to discharge was more likely during the more recent period because of group differences in ANS, AABX, and surfactant. However, this treatment shift may reflect an overall more aggressive management approach. More consistent application of treatment has led to improving survival of <25 week EGA infants during the post-surfactant era, but possibly at the cost of greater risk of major in-hospital morbidities.

Original languageEnglish
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
Volume90
Issue number2
DOIs
StatePublished - Mar 1 2005

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Surface-Active Agents
Morbidity
Mortality
Steroids
Gestational Age
Odds Ratio
Confidence Intervals
National Institute of Child Health and Human Development (U.S.)
Bronchopulmonary Dysplasia
Cohort Studies
Anti-Bacterial Agents
Survival
Therapeutics
Research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Changes in mortality and morbidities among infants born at less than 25 weeks during the post-surfactant era. / Hintz, S. R.; Poole, W. K.; Wright, L. L.; Fanaroff, A. A.; Kendrick, D. E.; Laptook, A. R.; Goldberg, R.; Duara, Shahnaz; Stoll, B. J.; Oh, W.

In: Archives of Disease in Childhood: Fetal and Neonatal Edition, Vol. 90, No. 2, 01.03.2005.

Research output: Contribution to journalArticle

Hintz, S. R. ; Poole, W. K. ; Wright, L. L. ; Fanaroff, A. A. ; Kendrick, D. E. ; Laptook, A. R. ; Goldberg, R. ; Duara, Shahnaz ; Stoll, B. J. ; Oh, W. / Changes in mortality and morbidities among infants born at less than 25 weeks during the post-surfactant era. In: Archives of Disease in Childhood: Fetal and Neonatal Edition. 2005 ; Vol. 90, No. 2.
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abstract = "Objectives: To compare mortality and death or major morbidity (DOMM) among infants <25 weeks estimated gestational age (EGA) born during two post-surfactant era time periods. Study design and patients: Comparative cohort study of very low birthweight (501-1500 g) infants <25 weeks EGA in the NICHD Neonatal Research Network born during two post-surfactant era time periods (group I, 1991-1994, n = 1408; group II, 1995-1998, n = 1348). Perinatal and neonatal factors were compared, and group related mortality and DOMM risk were evaluated. Results: Mortality was higher for group I (63.1{\%} v 56.7{\%}; p = 0.0006). Antenatal steroids (ANS) and antenatal antibiotics (AABX), surfactant (p<0.0001), and bronchopulmonary dysplasia (p = 0.0008) were more prevalent in group II. In a regression model that controlled for basic and delivery factors only, mortality risk was greater for group I than for group II (odds ratio (OR) 1.4, 95{\%} confidence interval (CI) 1.2 to 1.7); the addition of AABX and surfactant, or ANS (OR 0.97, 95{\%} CI 0.79 to 1.2) to the model appeared to account for this difference. There was no difference in DOMM (86.8{\%} v 88.4{\%}; p = 0.2), but risk was lower for group I in regression models that included ANS (OR 0.70, 95{\%} CI 0.52 to 0.94). Conclusion: Survival to discharge was more likely during the more recent period because of group differences in ANS, AABX, and surfactant. However, this treatment shift may reflect an overall more aggressive management approach. More consistent application of treatment has led to improving survival of <25 week EGA infants during the post-surfactant era, but possibly at the cost of greater risk of major in-hospital morbidities.",
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AU - Hintz, S. R.

AU - Poole, W. K.

AU - Wright, L. L.

AU - Fanaroff, A. A.

AU - Kendrick, D. E.

AU - Laptook, A. R.

AU - Goldberg, R.

AU - Duara, Shahnaz

AU - Stoll, B. J.

AU - Oh, W.

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N2 - Objectives: To compare mortality and death or major morbidity (DOMM) among infants <25 weeks estimated gestational age (EGA) born during two post-surfactant era time periods. Study design and patients: Comparative cohort study of very low birthweight (501-1500 g) infants <25 weeks EGA in the NICHD Neonatal Research Network born during two post-surfactant era time periods (group I, 1991-1994, n = 1408; group II, 1995-1998, n = 1348). Perinatal and neonatal factors were compared, and group related mortality and DOMM risk were evaluated. Results: Mortality was higher for group I (63.1% v 56.7%; p = 0.0006). Antenatal steroids (ANS) and antenatal antibiotics (AABX), surfactant (p<0.0001), and bronchopulmonary dysplasia (p = 0.0008) were more prevalent in group II. In a regression model that controlled for basic and delivery factors only, mortality risk was greater for group I than for group II (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2 to 1.7); the addition of AABX and surfactant, or ANS (OR 0.97, 95% CI 0.79 to 1.2) to the model appeared to account for this difference. There was no difference in DOMM (86.8% v 88.4%; p = 0.2), but risk was lower for group I in regression models that included ANS (OR 0.70, 95% CI 0.52 to 0.94). Conclusion: Survival to discharge was more likely during the more recent period because of group differences in ANS, AABX, and surfactant. However, this treatment shift may reflect an overall more aggressive management approach. More consistent application of treatment has led to improving survival of <25 week EGA infants during the post-surfactant era, but possibly at the cost of greater risk of major in-hospital morbidities.

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