News & Commentary

Extremely Premature Infants Benefit From Technology


Extremely premature infants stand a much better chance of surviving than they did 15 years ago thanks mostly to advances in respiratory technology, according to a study in the New England Journal of Medicine. That’s good news, but there’s still much more work to be done because 1 out of 4 of these tiny patients die in the hospital.

Researchers from Emory University School of Medicine and Children’s Healthcare of Atlanta examined 6,075 deaths among 22,248 infants in three periods: 2000–2003, 2004–2007, and 2008–2011.

According to the study, which was published Jan. 22, the gestational age of the infants across all study periods was 22 to 28 weeks, which is 12 to 18 weeks before normal due dates.

Gestational age and mortality rate, 2000–2011

Mortality rate per 1,000 live births

Source: "Causes and Timing of Death in Extremely Premature Infants from 2000 to 2011," New England Journal of Medicine, Jan. 22, 2015.

The hospitals in the study are part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.

Better management of respiratory distress syndrome and bronchopulmonary dysplasia accounted for more than half of the decrease in overall mortality. That decline was greatest between 2004 and 2007 (285 deaths per 1,000 live births), and 2008 and 2011 (258 deaths per 1,000 live births).

However, deaths from necrotizing enterocolitis, inflammation that damages the small and large intestines, increased significantly from 2000 to 2011. The researchers noted that better survival rates of premature infants means that infants who would have died earlier are now living long enough so they reach the age at which necrotizing enterocolitis occurs.

The lead author of the study, Ravi M. Patel, MD, tells Managed Care that “these complications have a substantial impact on long-term health outcomes, cost, and length of hospital stay for these infants. I think our findings, as well as those of other researchers, should continue to motivate researchers to identify new strategies to improve outcomes in this population.”

Overall, 40.4% of deaths occurred within 12 hours of birth, while 17.3% happened after 28 days.

The main cause of death for infants born at a gestational age of 22 or 23 weeks was immaturity, and most of these infants died within 12 hours after they were born.

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