ORIGINAL ARTICLE

¹ Division of Neonatology, Stanford University Medical Center, Palo Alto, CA, USA
² Research Triangle Institute, Research Triangle Park, NC, USA
³ Department of Pediatrics, National Institute of Child Health and Human Development, Bethesda, MD, USA
⁴ Case Western Reserve University, Cleveland, OH, USA
⁵ Department of Pediatrics, University of Texas-Southwestern Medical Center, Dallas, TX, USA
⁶ Duke University, Durham, NC, USA
⁷ Department of Pediatrics, University of Miami, Miami, FL, USA
⁸ Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
⁹ Department of Pediatrics, Brown University, Providence, RI, USA

Correspondence to:
Correspondence to:
Assistant Professor Hintz
Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, 750 Welch Road, Suite 315, Palo Alto, CA 94304 USA; srhintz{at}stanford.edu

Objectives: To compare mortality and death or major morbidity (DOMM) among infants <25 weeks estimated gestational age (EGA) born during two post-surfactant era time periods.

Study design and patients: Comparative cohort study of very low birthweight (501–1500 g) infants <25 weeks EGA in the NICHD Neonatal Research Network born during two post-surfactant era time periods (group I, 1991–1994, n = 1408; group II, 1995–1998, n = 1348). Perinatal and neonatal factors were compared, and group related mortality and DOMM risk were evaluated.

Results: Mortality was higher for group I (63.1% v 56.7%; p = 0.0006). Antenatal steroids (ANS) and antenatal antibiotics (AABX), surfactant (p<0.0001), and bronchopulmonary dysplasia (p = 0.0008) were more prevalent in group II. In a regression model that controlled for basic and delivery factors only, mortality risk was greater for group I than for group II (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.2 to 1.7); the addition of AABX and surfactant, or ANS (OR 0.97, 95% CI 0.79 to 1.2) to the model appeared to account for this difference. There was no difference in DOMM (86.8% v 88.4%; p = 0.2), but risk was lower for group I in regression models that included ANS (OR 0.70, 95% CI 0.52 to 0.94).

Conclusion: Survival to discharge was more likely during the more recent period because of group differences in ANS, AABX, and surfactant. However, this treatment shift may reflect an overall more aggressive management approach. More consistent application of treatment has led to improving survival of <25 week EGA infants during the post-surfactant era, but possibly at the cost of greater risk of major in-hospital morbidities.

Abbreviations: AABX, antenatal antibiotics; ANS, antenatal steroids; BPD, bronchopulmonary dysplasia; DOMM, death or major morbidity; EGA, estimated gestational age

Keywords: extremely premature; mortality; outcome; surfactant; very low birth weight

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