Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018
Authors: Edward F. Bell, Susan R. Hintz, Nellie I. Hansen, Carla M. Bann, Myra H. Wyckoff, Sara B. DeMauro, Michele C. Walsh, Betty R. Vohr, Barbara J. Stoll, Waldemar A. Carlo, Krisa P. Van Meurs, Matthew A. Rysavy, Ravi M. Patel, Stephanie L. Merhar, Pablo J. Sánchez, Abbot R. Laptook, Anna Maria Hibbs, C. Michael Cotten, Carl T. D’Angio, Sarah Winter, Janell Fuller, Abhik Das, Namasivayam Ambalavanan, Kirstin J. Bailey, Fred J. Biasini, Stephanie A. Chopko, Monica V. Collins, Shirley S. Cosby, Kristy A. Domnanovich, Chantel J. Jno-Finn, Morissa Ladinsky, Tara E. McNair, Mary Beth Moses, Myriam Peralta-Carcelen, Vivien A. Phillips, Julie Preskitt, Richard V. Rector, Kimberlly Stringer, Sally Whitley, Sheree York Chapman, Barbara Alksninis, Robert T. Burke, Angelita M. Hensman, Martin Keszler, Mary Lenore Keszler, Andrea M. Knoll, Theresa M. Leach, Elizabeth C. McGowan, Lucille St. Pierre, Elisa Vieira, Victoria E. Watson, Stephanie Guilford, Michelle E. Hartley-McAndrew, Satyan Lakshminrusimha, Emily Li, Anne Marie Reynolds, Michael G. Sacilowski, Ashley Williams, William A. Zorn, Harriet G. Friedman, None 0, Nancy S. Newman, Bonnie S. Siner, Deanne E. Wilson-Costello, Tanya E. Cahill, Teresa L. Gratton, Cathy Grisby, Kristin Kirker, Brenda B. Poindexter, Kurt Schibler, Sandra Wuertz, Kimberly Yolton, Richard A. Polin, Sally S. Adams, Luc P. Brion, Maria M. De Leon, Frances Eubanks, Alicia Guzman, Elizabeth T. Heyne, Roy J. Heyne, Lizette E. Lee, E. Rebecca McDougald, Lara Pavageau, Pollieanna Sepulveda, Catherine Twell Boatman, Diana M. Vasil, Azucena Vera, Jillian Waterbury, Patricia L. Ashley, Joanne Finkle, Kimberley A. Fisher, Ronald N. Goldberg, Ricki F. Goldstein, Kathryn E. Gustafson, Deesha Mago-Shah, William F. Malcolm, Ira Adams-Chapman (deceased), Diane I. Bottcher, David P. Carlton, Sheena L. Carter, Ellen C. Hale, Salathiel Kendrick-Allwood, Judith Laursen, Yvonne C. Loggins, Colleen Mackie, Maureen Mulligan LaRossa, Amy Sanders, Gloria V. Smikle, Lynn Wineski, Elizabeth Allain, Julie Arldt-McAlister, Fatima Boricha, Allison G. Dempsey, Andrea F. Duncan, Carmen Garcia, Donna J. Hall, Janice John, Kathleen A. Kennedy, Amir M. Khan, M. Layne Lillie, Karen Martin, Georgia Elaine McDavid, Shannon L. McKee, Ricardo A. Mosquera, Michelle Poe, Tina Reddy, Kimberly Rennie, Shawna Rodgers, Daniel K. Sperry, Emily K. Stephens, Jon E. Tyson, Sharon L. Wright, Heidi M. Harmon, Dianne E. Herron, Abbey C. Hines, Carolyn Lytle, Lu-Ann Papile, Lucy C. Smiley, Gregory M. Sokol, Jane E. Brumbaugh, Tarah T. Colaizy, Diane L. Eastman, Claire A. Goeke, Karen J. Johnson, Mendi L. Schmelzel, Jacky R. Walker, John A. Widness, Donia B. Bass, Dan L. Ellsbury, Tracy L. Tud, Lisa Gaetano, Cheri Gauldin, Anne M. Holmes, Kathy Johnson, Howard W. Kilbride, Eugenia K. Pallotto, Prabhu S. Parimi, Allison Scott, William E. Truog, Nancy Batterson, Hallie Baugher, Demi R. Beckford, Stephanie Burkhardt, Helen Carey, Michelle Chao, Courtney Cira, Erna Clark, Brittany DeSantis, Erin Fearns, Christine A. Fortney, Aubry Fowler, Jennifer L. Grothause, Julie Gutentag, Cole D. Hague, Sudarshan R. Jadcherla, Sarah A. Keim, Katelyn Levengood, Patricia Luzader, Nathalie L. Maitre, Laura Marzec, Jacqueline McCool, Bethany Miller, Leif D. Nelin, Mary Ann Nelin, Julia Newton, Courtney Park, Lindsay Pietruszewski, Jessica Purnell, Julie C. Shadd, Jonathan L. Slaughter, Kristi L. Small, Melanie Stein, Margaret Sullivan, Rox Ann Sullivan, Christopher J. Timan, Kyrstin Warnimont, Keith O. Yeates, Lina Yossef-Salameh, Andrew A. Bremer, Rosemary D. Higgins, Stephanie Wilson Archer, Soraya Abbasi, Judy C. Bernbaum, Aasma S. Chaudhary, Dara M. Cucinotta, Eric C. Eichenwald, Marsha Gerdes, Sarvin Ghavam, Hallam Hurt, Haresh Kirpalani, Toni Mancini, Barbara Schmidt, Jonathan M. Snyder, Kristina Ziolkowski, Kyle Binion, Melissa Bowman, Elizabeth Boylin, Kelly R. Coleman, Caitlin Fallone, Osman Farooq, Ronnie Guillet, Cassandra A. Horihan, Julianne Hunn, Rosemary L. Jensen, Rachel Jones, Jennifer Kachelmeyer, Alison Kent, Kimberly G. McKee, Joan Merzbach, Gary J. Myers, Constance Orme, Diane M. Prinzing, Daisy Rochez, Mary Rowan, Premini Sabaratnam, Ann Marie Scorsone, Holly I.M. Wadkins, Kelley Yost, Margaret M. Crawford, Jenna Gabrio, Marie G. Gantz, Jamie E. Newman, Jeanette O’Donnell Auman, Lindsay Parlberg, Carolyn M. Petrie Huitema, Dennis Wallace, Kristin M. Zaterka-Baxter, Michelle L. Baack, Megan Broadbent, Chelsey Elenkiwich, Megan M. Henning, Laurie A. Hogden, Marian M. Adams, Dona Bahmani, M. Bethany Ball, Barbara Bentley, Valerie Y. Chock, Maria Elena DeAnda, Anne M. DeBattista, Beth A. Earhart, Lynne C. Huffman, Casey E. Krueger, Ryan E. Lucash, Melinda S. Proud, Elizabeth N. Reichert, David K. Stevenson, Heather L. Taylor, Hali E. Weiss, R. Jordan Williams, Teresa Chanlaw, Uday Devaskar, Meena Garg, Rachel Geller, Isabell B. Purdy, Janice Bernhardt, Carl L. Bose, Gennie Bose, Matthew Maxwell Laughon, Jennifer Talbert, Diane D. Warner, Janice Kay Wereszczak, Conra Backstrom Lacy, Carol H. Hartenberger, Elizabeth Kuan, Jean R. Lowe, Robin K. Ohls, Mary Ruffner Hanson, Sandra Sundquist Beauman, Kristi L. Watterberg, John Barks, Martha D. Carlson, Mary K. Christensen, Diane F. White, Stephanie A. Wiggins, Shawna Baker, Mariana Baserga, Jill Burnett, Susan Christensen, Sean D. Cunningham, Brandy Davis, Jennifer O. Elmont, Roger G. Faix, Becky Hall, Erika R. Jensen, Manndi C. Loertscher, Trisha Marchant, Earl Maxson, Kandace M. McGrath, Hena G. Mickelsen, Stephen D. Minton, Galina Morshedzadeh, D. Melody Parry, Carrie A. Rau, Susan T. Schaefer, Mark J. Sheffield, Kelly Stout, Ashley L. Stuart, Kimberlee Weaver-Lewis, Kathryn D. Woodbury, Bradley A. Yoder, Alexandra Bentley, Laura Edwards, Stephen D. Kicklighter, Ginger Rhodes-Ryan, Donna White, Prashant Agarwal, Monika Bajaj, Rebecca Bara, Sanjay Chawla, Kirsten Childs, Melissa February, Laura A. Goldston, Eunice Hinz Woldt, Girija Natarajan, Athina Pappas, Seetha Shankaran, Beena G. Sood
Journal: JAMA (2022)

Despite improvement during recent decades, extremely preterm infants continue to contribute disproportionately to neonatal mortality and childhood morbidity. To review survival, in-hospital morbidities, care practices, and neurodevelopmental and functional outcomes at 22-26 months' corrected age for extremely preterm infants. Prospective registry for extremely preterm infants born at 19 US academic centers that are part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. The study included 10 877 infants born at 22-28 weeks' gestational age between January 1, 2013, and December 31, 2018, including 2566 infants born before 27 weeks between January 1, 2013, and December 31, 2016, who completed follow-up assessments at 22-26 months' corrected age. The last assessment was completed on August 13, 2019. Outcomes were compared with a similar cohort of infants born in 2008-2012 adjusting for gestational age. Extremely preterm birth. Survival and 12 in-hospital morbidities were assessed, including necrotizing enterocolitis, infection, intracranial hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia. Infants were assessed at 22-26 months' corrected age for 12 health and functional outcomes, including neurodevelopment, cerebral palsy, vision, hearing, rehospitalizations, and need for assistive devices. The 10 877 infants were 49.0% female and 51.0% male; 78.3% (8495/10848) survived to discharge, an increase from 76.0% in 2008-2012 (adjusted difference, 2.0%; 95% CI, 1.0%-2.9%). Survival to discharge was 10.9% (60/549) for live-born infants at 22 weeks and 94.0% (2267/2412) at 28 weeks. Survival among actively treated infants was 30.0% (60/200) at 22 weeks and 55.8% (535/958) at 23 weeks. All in-hospital morbidities were more likely among infants born at earlier gestational ages. Overall, 8.9% (890/9956) of infants had necrotizing enterocolitis, 2.4% (238/9957) had early-onset infection, 19.9% (1911/9610) had late-onset infection, 14.3% (1386/9705) had severe intracranial hemorrhage, 12.8% (1099/8585) had severe retinopathy of prematurity, and 8.0% (666/8305) had severe bronchopulmonary dysplasia. Among 2930 surviving infants with gestational ages of 22-26 weeks eligible for follow-up, 2566 (87.6%) were examined. By 2-year follow-up, 8.4% (214/2555) of children had moderate to severe cerebral palsy, 1.5% (38/2555) had bilateral blindness, 2.5% (64/2527) required hearing aids or cochlear implants, 49.9% (1277/2561) had been rehospitalized, and 15.4% (393/2560) required mobility aids or other supportive devices. Among 2458 fully evaluated infants, 48.7% (1198/2458) had no or mild neurodevelopmental impairment at follow-up, 29.3% (709/2419) had moderate neurodevelopmental impairment, and 21.2% (512/2419) had severe neurodevelopmental impairment. Among extremely preterm infants born in 2013-2018 and treated at 19 US academic medical centers, 78.3% survived to discharge, a significantly higher rate than for infants born in 2008-2012. Among infants born at less than 27 weeks' gestational age, rehospitalization and neurodevelopmental impairment were common at 2 years of age.