Survival and neurodevelopmental outcomes among periviable infants

Abstract

confounding variables, both the rate of survival without neurodevelopmental impairment (1.59; 95% confidence interval [The purpose of this study was to evaluate survival and neurodevelopmental outcomes among periviable infants (born at 22-24 weeks of gestation) assessed at 18 to 22 months of corrected age. In the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network (NRN) alone, this improvement has been documented for over 2 decades now with increasing survival of infants born after 2008 at 23 to 24 weeks of gestation. However, there has been less information on longer-term outcomes. Specifically, the authors examined whether survival and survival without neurodevelopmental impairment improved between 2000 and 2011. The hypothesis was tested on 4458 infants born between 22 weeks 0 days and 24 weeks 6 days of gestation in the period January 1, 2000, to December 31, 2011, enrolled in the NICHD NRN generic database registry at 11 academic tertiary care centers. This study period was further divided into 3 birth-year epochs (2000-2003, 2004-2007, 2008-2011). Themultinomial generalized logit models compared the relative risk of (i) death, (ii) survival with neurodevelopmental impairment, and (iii) survivalwithout neurodevelopmental impairment. These outcomes were examined after compensating for variations in infant characteristics, including birth center. These outcomes were available for 96% of the infants registered (n = 4274). It was found that the rate of survival increased significantly from 424 of 1391 infants (30%) in epoch 1 (2000-2003) to 487 of 1348 infants (36%) in epoch 3 (2008-2011, P <0.001). Also, the rate of survival without neurological impairment increased from 217 of 1391 (16%) in epoch 1 to 276 of 1348 (20%, P = 0.001) in epoch 3, whereas there was no significant change in the rate of survival of infants with neurological impairment in the same period (15% [207 of 1391] in epoch 1 and 16% [211 of 1348] in epoch 3, P = 0.29). However, when controlling for potentialCI], 1.28-1.99) and the rate of survival with neurodevelopmental impairment increased (1.27; 95% CI, 1.01-1.59). In addition, when the ratio between those with impairment and those without was compared, there was no statistically significant difference over time in either neurodevelopmental impairment (1.27; 95% CI, 0.99-1.65) or neurosensory impairment (0.93; 95% CI, 0.66-1.32). Thus, the data from 2000 to 2011 regarding periviable infants from the NICHD NRN registry demonstrated that while the rate of survival of those without neurodevelopmental impairment improved, so did the rate of survival of those with neurodevelopmental impairment.