Format

Send to

Choose Destination
N Engl J Med. 2017 Feb 16;376(7):617-628. doi: 10.1056/NEJMoa1605566.

Survival and Neurodevelopmental Outcomes among Periviable Infants.

Collaborators (358)

Jobe AH, Caplan MS, Polin RA, Laptook AR, Keszler M, Oh W, Hensman AM, Alksninis B, Basso KM, Burke R, Caskey M, Halbrook A, Johnson K, Keszler ML, Leach TM, Leonard MR, Noel L, Stephens BE, Vogt RA, Watson VE, Ventura S, Yatchmink Y, Walsh MC, Fanaroff AA, Wilson-Costello DE, Newman NS, Hibbs AM, Bhola M, Siner BS, Friedman HG, Yalcinkaya G, Truog WE, Pallotto EK, Kilbride HW, Gauldin C, Holmes A, Johnson K, Schibler K, Donovan EF, Grisby C, Alexander B, Bridges K, Fischer EE, Gratton TL, Hessling J, Jackson LD, Kirker K, Mincey HL, Muthig G, Steichen JJ, Mersmann MW, Yolton K, Finkle J, Ashley PL, Malcolm WF, Auten KJ, Fisher KA, Foy KA, Grimes S, Gustafson KE, Lohmeyer MB, Laughon MM, Bose CL, Bernhardt J, Bose G, Wereszczak JK, Stoll BJ, Carlton DP, Adams-Chapman I, Carter S, Dinkins E, Hale EC, Loggins YC, Carter SL, LaRossa MM, Smikle GV, Wright LL, McClure EM, Archer SW, Poindexter BB, Sokol GM, Lemons JA, Bohnke LG, Cook AB, Dusick AM, Eaken G, Hamer F, Herron DE, Hines AC, Lytle C, Miller LC, Minnich HM, Papile LA, Richard L, Wilson LD, Sánchez PJ, Nelin LD, Jadcherla SR, Luzader P, Fortney CA, Besner GE, Parikh NA, Wallace D, Gantz MG, Crawford MM, Hastings BK, Newman JE, Auman JO, Petrie Huitema CM, Zaterka-Baxter KM, Van Meurs KP, Stevenson DK, Ball MB, Adams MM, Ahlfors CE, Baran JM, Bentley B, Bond LE, Brudos GK, Bruno E, Davis AS, DeAnda ME, DeBattista AM, Epcar JT, Fleisher BE, Huffman LC, Ismael M, Kohn JG, Kuelper CG, Lee-Ancajas JC, Palmquist AW, Proud MS, Pyle RP, Sivakumar D, Stebbins RD, St. John NH, Tang B, Weiss HE, Frantz ID III, Fiascone JM, McGowan EC, MacKinnon BL, Brussa AK, Furey A, Nylen E, Sibley CE, Carlo WA, Ambalavanan N, Peralta-Carcelen M, Nelson KG, Collins MV, Cosby SS, Bailey KJ, Biasini FJ, Chopko SA, Domnanovich K, Johnston KC, Kiser C, Kryzwanski S, Moses MB, Patterson CS, Phillips VA, Preskitt J, Rector RV, Rodrigues L, Ryan S, Smith LA, Soong AD, Whitley S, Devaskar U, Garg M, Purdy IB, Chanlaw T, Geller R, Finer NN, Vaucher YE, Kaegi D, Rasmussen MR, Wozniak PR, Arnell K, Bridge R, Demetrio C, Fuller MG, Henderson C, Posin D, Rich W, West R, Colaizy TT, Widness JA, Ellsbury DL, Johnson KJ, Acarregui MJ, Brumbaugh JE, Campbell DB, Eastman DL, Krutzfield NJ, Walker JR, Bauer CR, Duara S, Everett-Thomas R, Worth AM, Allison M, Calejo M, Diaz AN, Hamlin-Smith K, Jean-Gilles L, Fajardo-Hiriart S, Frade Eguaras SM, Garcia A, Gideon YC, Berkowits MH, Mathews EO, Pierre H, Rigaud A, Stoerger A, Watterberg KL, Ohls RK, Lacy CB, Fuller JF, Brown S, Hartenberger C, Lowe JR, Montman RA, Schmidt B, Kirpalani H, DeMauro SB, Chaudhary AS, Abbasi S, Mancini T, Cucinotta DM, Bernbaum JC, Gerdes M, Hurt H, D’Angio CT, Phelps DL, Guillet R, Myers GJ, Reubens LJ, Burnell E, Hust D, Johnson JB, Hunn J, Jensen RL, Kushner E, Maffett D, Merzbach J, Rowan M, Wadkins HI, Yost K, Zwetsch L, Lakshminrusimha S, Reynolds AM, Osman F, Williams A, Wynn K, Korones SB, Bada HS, Hudson T, Williams M, Kennedy KA, Tyson JE, McDavid GE, Akpa EG, Alaniz NI, Bradt PJ, Burson K, Cluff PA, Dieterich S, Evans PW, Harris BF, Franco CI, Green C, Jiminez M, Lis AE, Major-Kincade T, Martin S, Morris BH, Poundstone ML, Reddoch S, Robichaux P, Siddiki S, Simmons MC, Pierce Tate PL, Whitely LL, Wright SL, Brion LP, Rosenfeld CR, Salhab WA, Heyne RJ, Broyles RS, Vasil DM, Adams SS, Chen L, Dooley C, Guzman A, Hensley G, Heyne ET, Hickman JF, Leps MH, Madden LA, Madison S, Miller NA, Morgan JS, Torres LE, Boatman CT, Faix RG, Yoder BA, Bodnar A, Osborne KA, Baker S, Cole L, Jensen JJ, Spencer C, Steffen M, Weaver-Lewis K, Winter S, Zanetti K, O’Shea TM, Dillard RG, Washburn LK, Jackson BG, Peters NJ, Chiu K, Allred DE, Goldstein DJ, Halfond R, Peterson C, Waldrep EL, Welch CD, Morris MW, Hounshell GW, Shankaran S, Pappas A, Barks J, Bara R, Argento A, Carlson M, Christensen M, Driscoll D, Goldston LA, Johnson M, Johnson YR, Kennedy D, Muran G, Wiggins S, Ehrenkranz RA, Jacobs H, Butler CG, Close N, Cervone P, Gettner P, Gilliam W, Greisman S, Konstantino M, Poulsen J, Taft J, Williams J, Romano E.

Author information

1
From the Department of Pediatrics, Duke University, Durham (N.Y., R.F.G., P.B.S., R.N.G., C.M.C.), and the Statistics and Epidemiology Unit, RTI International, Research Triangle Park (C.M.B., A.D.) - both in North Carolina; the Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA (S.R.H.); the Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (R.M.P.); the Department of Pediatrics, University of Iowa, Iowa City (E.F.B., M.A.R.); the Department of Pediatrics, University of Wisconsin, Madison (M.A.R.); the Department of Pediatrics, University of Texas Medical School at Houston, Houston (A.F.D.); the Department of Pediatrics, Women and Infants' Hospital, Brown University, Providence, RI (B.R.V.); and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (R.D.H.).

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. (Funded by the National Institutes of Health and others; ClinicalTrials.gov numbers, NCT00063063 and NCT00009633 .).

PMID:
28199816
PMCID:
PMC5456289
DOI:
10.1056/NEJMoa1605566
[Indexed for MEDLINE]
Free PMC Article

Publication type, MeSH terms, Secondary source ID, Grant support

Publication type

MeSH terms

Secondary source ID

Grant support

Supplemental Content

Full text links

Icon for Atypon Icon for PubMed Central
Loading ...
Support Center