Factors Predict Survival in Extreme Prematurity

April 16, 2008

The decision to administer intensive care to an extremely premature infant is often based on gestational age alone, but factors such as birth weight, sex and exposure to antenatal corticosteroids also impact prognosis and should be taken into consideration, researchers report in the April 17 issue of the New England Journal of Medicine.

WEDNESDAY, April 16 (HealthDay News) -- The decision to administer intensive care to an extremely premature infant is often based on gestational age alone, but factors such as birth weight, sex and exposure to antenatal corticosteroids also impact prognosis and should be taken into consideration, researchers report in the April 17 issue of the New England Journal of Medicine.

Jon E. Tyson, M.D., of the University of Texas Medical School at Houston, and colleagues prospectively followed 4,446 infants born at 22 to 25 weeks' gestation in the Neonatal Research Network of the National Institute of Child Health and Human Development, to investigate factors predicting survival and neurodevelopmental impairment at a corrected age of 18 to 22 months in infants with extreme prematurity.

Eighty-three percent of the infants in the cohort received mechanical ventilation, the researchers report. In the 94 percent of babies in whom follow-up was completed, 49 percent had died, 61 percent had died or had profound impairment and 73 percent had died or had impairment by 18 to 22 months, the report indicates. Multivariate analysis showed that exposure to antenatal corticosteroids, female sex, singleton birth and higher birth weight reduced the risk of death or impairment in an amount comparable to a one-week increase in gestational age.

"Whatever minimum probability of a favorable outcome is judged to warrant intensive care, consideration of multiple factors is likely to promote treatment decisions that are less arbitrary, more individualized, more transparent and better justified than decisions based solely on gestational-age thresholds," the authors conclude.

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