Thanks to best practices, the survival rate of babies born at 22 and 23 weeks has improved dramatically over the past decade
A new study co-authored by a researcher at the University of Rochester Medical Center (URMC) has found that survival rates for extremely premature babies have increased dramatically over the past decade.
The article, “Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018,” examined the survival outcomes of 10,877 infants born at 22-28 weeks d gestational age between January 1, 2013 and December 31, 2018, at 19 academic medical centers that form the NIH-funded Neonatal Research Network.
Survival of actively treated infants was 30.0% (60/200) at 22 weeks and 55.8% (535/958) at 23 weeks. This is a significantly higher survival rate than when the study was previously conducted between 2008 and 2012, in which survival to discharge was 7% (22/334) for infants born alive at 22 weeks. and 32% (252/779) for infants born alive at 23 weeks.
This improved outcome for extremely preterm infants can be attributed to several factors, including improved treatment protocols at participating medical centers, according to Carl D’Angio, MD, co-author and chief of the division of neonatology at the URMC.
“Academic medical centers have taken the best practices, applied them, and disseminated them to a growing group nationwide,” D’Angio said.
The collective improvement of care in various areas has contributed to the evolution of results, according to D’Angio. “When we look at the survival of almost any group of infants, it is a combination of factors. There are similarities and differences in how they are treated in various centers, but there are elements on which we have collectively made progress, such as ventilation, nutrition and hydration.”
When infants are born at 22 or 23 weeks, nearly every organ is immature, with the lungs and brain being among the systems most at risk, according to D’Angio.
In addition to studying survival outcomes, the paper assessed the health of severely preterm infants after two years, including effects such as neurodevelopment, cerebral palsy, vision, hearing, rehospitalizations, and need assistive devices. Just over 8% had moderate to severe cerebral palsy, 1.5% had vision loss in both eyes, 2.5% needed hearing aids or cochlear implants, and 15% needed aids mobility such as orthoses, braces, walkers or wheelchairs.
Almost 49% had no or only mild neurodevelopmental impairment, approximately 29% had moderate neurodevelopmental impairment, and approximately 21% had severe neurodevelopmental impairment.
This study — and the overall improved results — can help clinicians provide clear information when discussing with families when babies are born extremely premature.
“As clinicians, we support parents in a shared decision-making process when babies are born at the edge of viability,” D’Angio said. “The imminent delivery of an extremely premature baby is a major stressor for families. To help parents cope, it is important to present the data we have and let parents know what to expect. This latest study is positive news to shape those discussions and provide a more optimistic likelihood for good outcomes.”
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Material provided by University of Rochester Medical Center. Original written by Scott Hesel. Note: Content may be edited for style and length.