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I. Patterns of development

  1. Survival and outcome

    1. Extreme prematurity

      1. Advances in antenatal and perinatal medicine and enhanced neonatal interventions for management of nutrition and respiratory function have resulted in improved survival of very preterm infants in the past 20 years, including infants at the limits of viability (22 to 25 weeks).

      2. Survival rates in the early 2000s were approximately 85% for very low birthweight (VLBW, ≤1500 g) and 70% for ELBW infants. A 2012 NICHD study of infants 404 to 1000 g between 22 and 27-6/7 weeks' gestation born in 2002-2008 reported a death rate of 61% for infants of 22 to 24 weeks compared to 19% for infants 25 to 27 weeks' gestation.

      3. The rate of combined death or neurodevelopmental impairment or death was 77% for infants 22 to 24 weeks and 38% for infants 25 to 27 weeks.

    2. Center variation

      1. Wide center variations in obstetrical and neonatal interventions among infants at 22 to 24 weeks' gestation are reported.

      2. Wide center variation in management is a factor that contributes to survival and outcome.

      3. In a 2012 report of infants 22 to 27 weeks' gestation, center rates of use of antenatal corticosteroids ranged from 28% to 100%, cesarean section ranged from 13% to 65%, and resuscitation from 30% to 100%. Centers with higher rates of antenatal corticosteroid use had the lower rates of death and neonatal morbidities.

      4. Table 50-1 shows recent reports of survival of infants 22 to 25 weeks' gestation from the United States and abroad. Survival at 22 weeks remains less than 10% except for a single report from Japan. Most recent studies report at least 40% survival by 24 weeks.

    3. Survival and outcome

      1. Improvements in survival have not always been accompanied by proportional reductions in the incidence of adverse neurologic, developmental, and behavioral outcomes.

TABLE 50-1.

Survival of infants 22 to 25 weeks' gestation

II. Assessment tools

III. Interval visits

According to corrected age in preterm infants and actual age in high-risk term infants.

  1. Motor development assessment

    1. Motor assessments for the very high-risk infants (ELBW, HIE, CDH, etc) should be considered at 1 month postdischarge, and 4 and 9 months.

    2. After 9 months, motor evaluations should be done in conjunction with evaluation of other developmental domains (cognitive, language, behavior).

  2. Complete neurodevelopmental testing

    1. Recommended intervals for neurodevelopmental assessment include

      1. 12 months

      2. 18 to 24 months

      3. 3 to 4 years


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