TY  - CHAP
M1  - Book, Section
TI  - Neurodevelopmental Follow-Up and Outcomes
A1  - Malcolm, William F.
PY  - 2015
T2  - Beyond the NICU: Comprehensive Care of the High-Risk Infant
AB  - Survival  and  outcomeExtreme  prematurityAdvances  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).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.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.Center  variationWide  center  variations  in  obstetrical  and  neonatal  interventions  among  infants  at  22  to  24  weeks'  gestation  are  reported.Wide  center  variation  in  management  is  a  factor  that  contributes  to  survival  and  outcome.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.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.Survival  and  outcomeImprovements  in  survival  have  not  always  been  accompanied  by  proportional  reductions  in  the  incidence  of  adverse  neurologic,  developmental,  and  behavioral  outcomes.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/23
UR  - accesspediatrics.mhmedical.com/content.aspx?aid=1105545727
ER  -