Providing care to very early preterm infants is often challenging.
Physicians and family members can be reluctant to expose an infant to
sometimes painful life-support procedures. Those offered active
treatment may survive, but may have hearing loss, blindness, cerebral
palsy, and severe intellectual disability.
Very early preterm infants are more likely to survive than in
previous years, and the survivors are less likely to have neurological
problems, revealed an analysis of records from a National Institutes
of Health research network.
‘Advances in the care provided to expectant mothers and their newborns has resulted in improved survival of very early preterm infants than in previous years. Also, the survivors are less likely to have neurological problems.’
Researchers found that of the more than 4,000 infants born at 11
sites within the network from 2000 to 2011, survival rates increased
from 30% to 36%. The proportion of survivors who did not
have a neurological or developmental impairment increased from 16% to 20%.
The authors theorize that these improvements are a
result of advances in the care provided to expectant mothers and their
newborns. The study appears in the New England Journal of Medicine
"Our study provides important information for physicians and family
members planning the care of these extremely fragile newborns," said
study author Rosemary Higgins, a program scientist at NIH's Eunice
Kennedy Shriver National Institute of Child Health and Human
Development (NICHD). The study was conducted by researchers in the
NICHD-funded Neonatal Research Network.
Infants in the study were born between the 22nd and 24th week of
pregnancy, far earlier than the 40 weeks generally expected for a
pregnancy to reach term. Those born from 2008 to 2011 had the lowest
death rate (64%). From 2004 to 2007, the death rate was 70%, unchanged from 2000 to 2003.
Dr. Higgins stressed that the results encompass trends for a large
number of infants at multiple research sites, but they should not be
used to predict the outcome for an individual child.
"Every individual is different, and no single source of information
can precisely predict a baby's chances of survival or disability," she
said. "But our study's findings do provide important information that
physicians and family members can consult to help determine treatment
The study authors wrote that, in the past, many experts had feared
that advances leading to improvements in survival among extremely
preterm infants might also result in a higher proportion of infants with
disabilities. However, in the current study, researchers found that
across all three time intervals, the percentage of infants who survived
with a disability did not change significantly.
The authors wrote that the increases in overall survival and
survival without neurological harm likely result from improvements in
the care given to mothers and newborns. One potential contributing
factor is the wider use of antenatal steroids. These drugs, which are
given to women at risk for preterm birth, help the infant's lungs
mature, leaving the infant less reliant on ventilation therapy, which
can sometimes damage the lungs and lead to infections.