Babies born extremely premature have shown modest increases in survival and reductions in neonatal complications in the last 20 years. Experts say changes in maternal and infant care may explain why.
Overall survival increased most significantly in infants born at 23-24 weeks, but survival without major health problems identified prior to hospital discharge increased most in infants 25-28 weeks. The study did find an increase in one complication of prematurity: bronchopulmonary dysplasia.
The review analyzed more than 34,000 deliveries of babies born at 22-28 weeks gestational age and 401 to 1500 grams birth weight between 1993 and 2012 in the United States.
“This study is the first comprehensive NRN review to evaluate 20 years of changes in care practices, major health problems, and survival of extremely premature infants,” says Barbara Stoll, professor and chair of pediatrics at Emory University School of Medicine.
“Our findings show that progress is being made and outcomes are improving. This information should be valuable in counseling families and in developing new interventions to help prevent and treat significant health problems in these infants.”
Survival Rates
Changes in care of preterm infants over the 20 years include an increase in antenatal corticosteroid use, an increase in cesarean delivery, and a decrease in delivery room intubation. Between 2002 and 2012 there was an increase in continuous positive airway pressure without ventilation. The 1990s saw an increase in postnatal steroid use, followed by a decrease until 2004.
Although rates of most serious health problems declined, bronchopulmonary dysplasia increased between 2009 and 2012 for infants born at 26-27 weeks but did not change significantly for infants born at 22-25 or 28 weeks. The authors note a decrease in late-onset sepsis between 2005 and 2012.
