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Pediatrics. 2011 Jan;127(1):62-70. doi: 10.1542/peds.2010-1150. Epub 2010 Dec 27.

Early-childhood neurodevelopmental outcomes are not improving for infants born at <25 weeks' gestational age.

Collaborators (152)

Hintz SR, Kendrick DE, Wilson-Costello DE, Das A, Bell EF, Vohr BR, Higgins RD, Jobe AH, Oh W, Laptook AR, Alksninis B, Hensman AM, Leach TM, Leonard MR, Noel LN, Vogt RA, Watson VE, Walsh MC, Fanaroff AA, Newman NS, Siner BS, Friedman HG, Donovan EF, Steichen JJ, Alexander B, Grisby C, Mersmann MW, Mincey HL, Hessling J, Gratton TL, Stoll BJ, Adams-Chapman I, Carter S, Dinkins E, Hale EC, LaRossa M, Smikle GV, Wright LL, McClure EM, Poindexter BB, Lemons JA, Bull M, Dusick AM, Kardatzke D, Lytle C, Appel DD, Bohnke LG, Eaken G, Herron DE, Miller LC, Minnich HM, Richard L, Wilson LD, Poole W, Hastings B, McClure EM, Auman JO, Huitema C, Schaefer SE, Stevenson DK, Van Meurs KP, Hintz S, Ahlfors CE, Stebbins RD, Kohn JG, Sivakumar D, Ball M, Kuelper CG, Lee-Ancajas JC, Baran JM, Bond LE, Brudos GK, DeBattista AM, Pyle RP, St John NH, Carlo WA, Peralta-Carcelen M, Nelson KG, Bailey KJ, Biasini FJ, Chopko SA, Collins MV, Cosby SS, Moses MB, Phillips VA, Preskitt J, Rector RV, Whitley S, Duara S, Bauer CR, Allison M, Everett-Thomas R, Diaz AN, Mathews EO, Ka Hamlin-Smith K, Jean-Gilles L, Calejo M, Frade Eguaras SM, Hiriart-Fajardo S, Gideon YC, Laptook AR, Rosenfeld CR, Salhab WA, Heyne RJ, Broyles R, Adams SS, Boatman CT, Dooley C, Guzman A, Hensley G, Heyne E, Hickman JF, Madden LA, Miller NA, Morgan JS, Madison S, Tyson JE, Kennedy KA, Akpa EG, Cluff PA, Franco CY, Lis AE, McDavid GE, Tate PL, Alaniz NI, Bradt PJ, Cedillo M, Dieterich S, Evans P, Major-Kincade T, Morris BH, Simmons MC, Whitely LL, Wright SL, Shankaran S, Pappas A, Johnson YR, Delaney-Black V, Bara R, Driscoll D, Goldston L, Kennedy D, Muran G, Ehrenkranz RA, Gettner P, Close N, Gilliam W, Konstantino M, Poulsen J, Romano E, Taft J, Williams J.

Author information

  • 1Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304, USA. srhintz@stanford.edu

Abstract

OBJECTIVE:

We compared neurodevelopmental outcomes at 18 to 22 months' corrected age of infants born with extremely low birth weight at an estimated gestational age of <25 weeks during 2 periods: 1999-2001 (epoch 1) and 2002-2004 (epoch 2).

PATIENTS AND METHODS:

We conducted a multicenter, retrospective analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Perinatal and neonatal variables and outcomes were compared between epochs. Neurodevelopmental outcomes at 18 to 22 months' corrected age were evaluated with neurologic exams and Bayley Scales of Infant Development II. Logistic regression analyses determined the independent risk of epoch for adverse outcomes.

RESULTS:

Infant survival was similar between epochs (epoch 1, 35.4%, vs epoch 2, 32.3%; P = .09). A total of 411 of 452 surviving infants in epoch 1 and 405 of 438 surviving infants in epoch 2 were evaluated at 18 to 22 months' corrected age. Cesarean delivery (P = .03), surgery for patent ductus arteriosus (P = .004), and late sepsis (P = .01) were more common in epoch 2, but postnatal steroid use was dramatically reduced (63.5% vs 32.8%; P < .0001). Adverse outcomes at 18 to 22 months' corrected age were common in both epochs. Moderate-to-severe cerebral palsy was diagnosed in 11.1% of surviving infants in epoch 1 and 14.9% in epoch 2 (adjusted odds ratio [OR]: 1.52 [95% confidence interval (CI): 0.86-2.71]; P = .15), the Mental Developmental Index was <70 in 44.9% in epoch 1 and 51% in epoch 2 (OR: 1.30 [95% CI: 0.91-1.87]; P = .15), and neurodevelopmental impairment was diagnosed in 50.1% of surviving infants in epoch 1 and 58.7% in epoch 2 (OR: 1.4 [95% CI: 0.98-2.04]; P = .07).

CONCLUSIONS:

Early-childhood outcomes for infants born at <25 weeks' estimated gestational age were unchanged between the 2 periods.

PMID:
21187312
[PubMed - indexed for MEDLINE]
PMCID:
PMC3375467
Free PMC Article

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