Impact of extreme low birth weight and early hypoxemic respiratory failure on survival


Extreme low birth weight is linked to suboptimal outcomes. A new report looks at how early hypoxemic respiratory failure and extreme low birth weight can influence survival.

An extremely low birth weight can be linked with many less than optimal outcomes in life. A report in Pediatrics examines whether extremely low birth weight combined with early hypoxemic respiratory failure to impact survival and neurodevelopmental impairment in young children aged 18 to 26 months.1 The study also examined whether exposure to inhaled nitric oxide improved the outcomes for African American infants who had early hypoxemic respiratory failure.

The researchers used the Neonatal Research Network to find infants who had a weight ≤ 1000g, had a gestational age ≤ 26 weeks, had maximal oxygen ≥ 60% on either day 1 or day 3, were labeled early hypoxemic respiratory failure, and were born between 2007 to 2015. They used a propensity score regression model to analyze the outcomes.

There were 7639 infants with extremely low birth weight who were born ≤ 26 weeks. In this group, 22.7% of the infants had early hypoxemic respiratory failure. The investigators found that early hypoxemic respiratory failure was linked with a mortality of 51.3%. They also found the incidence of moderate-to-severe neurodevelopmental impairment was 41.2% in infants at 18 to 26 months of age. Among the infants who were treated with inhaled nitric oxide, the mortality was found to be 59.4%. Intact survival was linked to a complete course of antenatal steroids (adjusted odds ratio [aOR]: 1.6, 95% CI: 1.1–2.2), being female (aOR: 2.4, 95% CI: 1.8–3.3), and having a birth weight ≥ 720 g. Infants who were African American were found to have a similar incidence of early hypoxemic respiratory failure, 21.7% versus 23.3%. However, they were found to have lower exposure to inhaled nitric oxide, 16.4% versus 21.6%. Intact survival, which meant no death or neurodevelopmental impairment, had no significant difference between African-American infants and other races (aOR: 1.5, 95% CI: 0.6–3.6), when looking at infants with hypoxemic respiratory failure who were exposed to inhaled nitric oxide.

The researchers concluded that early hypoxemic respiratory failure in infants with ≤ 26 weeks is linked with both high mortality and high neurodevelopment impairment at 18 to 26 years. Additionally, the use of inhaled nitric oxide was not found to decrease either mortality or neurodevelopment and those outcomes were not different among African American infants.


1. Chandrasekharan P, Lakshminrusimha S, Chowdhury D, et al. Early hypoxic respiratory failure in extreme prematurity: mortality and neurodevelopmental outcomes. Pediatrics. September 17, 2020. Epub ahead of print. doi:10.1542/peds.2019-3318

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