Survival and neurodevelopmental outcomes among periviable infants

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

Research output: Contribution to journalArticle

114 Citations (Scopus)

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

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Survival Rate
Birthing Centers
National Institute of Child Health and Human Development (U.S.)
Confidence Intervals
Logistic Models
Outcome Assessment (Health Care)
Parturition
Pregnancy
Mortality
Research

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (2017). Survival and neurodevelopmental outcomes among periviable infants. New England Journal of Medicine, 376(7), 617-628. https://doi.org/10.1056/NEJMoa1605566

Survival and neurodevelopmental outcomes among periviable infants. / Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.

In: New England Journal of Medicine, Vol. 376, No. 7, 16.02.2017, p. 617-628.

Research output: Contribution to journalArticle

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network 2017, 'Survival and neurodevelopmental outcomes among periviable infants', New England Journal of Medicine, vol. 376, no. 7, pp. 617-628. https://doi.org/10.1056/NEJMoa1605566
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Survival and neurodevelopmental outcomes among periviable infants. New England Journal of Medicine. 2017 Feb 16;376(7):617-628. https://doi.org/10.1056/NEJMoa1605566
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. / Survival and neurodevelopmental outcomes among periviable infants. In: New England Journal of Medicine. 2017 ; Vol. 376, No. 7. pp. 617-628.
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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.",
author = "{Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network} and Noelle Younge and Goldstein, {Ricki F.} and Bann, {Carla M.} and Hintz, {Susan R.} and Patel, {Ravi M.} and Smith, {P. Brian} and Bell, {Edward F.} and Rysavy, {Matthew A.} and Duncan, {Andrea F.} and Vohr, {Betty R.} and Abhik Das and Goldberg, {Ronald N.} and Higgins, {Rosemary D.} and Cotten, {C. Michael} and Jobe, {A. H.} and Caplan, {M. S.} and Polin, {R. A.} and Laptook, {A. R.} and M. Keszler and W. Oh and Hensman, {A. M.} and B. Alksninis and Basso, {K. M.} and R. Burke and M. Caskey and A. Halbrook and K. Johnson and Keszler, {M. L.} and Leach, {T. M.} and Leonard, {M. R.} and L. Noel and Stephens, {B. E.} and Vogt, {R. A.} and Watson, {V. E.} and S. Ventura and Y. Yatchmink and Walsh, {M. C.} and Fanaroff, {A. A.} and Wilson-Costello, {D. E.} and Newman, {N. S.} and Hibbs, {A. M.} and M. Bhola and Siner, {B. S.} and Friedman, {H. G.} and G. Yalcinkaya and Truog, {W. E.} and Pallotto, {E. K.} and Kilbride, {H. W.} and C. Gauldin and Satyanarayana Lakshminrusimha",
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TY - JOUR

T1 - Survival and neurodevelopmental outcomes among periviable infants

AU - Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

AU - Younge, Noelle

AU - Goldstein, Ricki F.

AU - Bann, Carla M.

AU - Hintz, Susan R.

AU - Patel, Ravi M.

AU - Smith, P. Brian

AU - Bell, Edward F.

AU - Rysavy, Matthew A.

AU - Duncan, Andrea F.

AU - Vohr, Betty R.

AU - Das, Abhik

AU - Goldberg, Ronald N.

AU - Higgins, Rosemary D.

AU - Cotten, C. Michael

AU - Jobe, A. H.

AU - Caplan, M. S.

AU - Polin, R. A.

AU - Laptook, A. R.

AU - Keszler, M.

AU - Oh, W.

AU - Hensman, A. M.

AU - Alksninis, B.

AU - Basso, K. M.

AU - Burke, R.

AU - Caskey, M.

AU - Halbrook, A.

AU - Johnson, K.

AU - Keszler, M. L.

AU - Leach, T. M.

AU - Leonard, M. R.

AU - Noel, L.

AU - Stephens, B. E.

AU - Vogt, R. A.

AU - Watson, V. E.

AU - Ventura, S.

AU - Yatchmink, Y.

AU - Walsh, M. C.

AU - Fanaroff, A. A.

AU - Wilson-Costello, D. E.

AU - Newman, N. S.

AU - Hibbs, A. M.

AU - Bhola, M.

AU - Siner, B. S.

AU - Friedman, H. G.

AU - Yalcinkaya, G.

AU - Truog, W. E.

AU - Pallotto, E. K.

AU - Kilbride, H. W.

AU - Gauldin, C.

AU - Lakshminrusimha, Satyanarayana

PY - 2017/2/16

Y1 - 2017/2/16

N2 - 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.

AB - 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.

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