Extremely preterm infants: 1 in 5 who receive active treatment survives

  • Brumbaugh JE & al.
  • JAMA Pediatr
  • 25 Mar 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Extremely preterm infants (
  • Among survivors, intracerebral hemorrhage and later impairments are common.

Why this matters

  • Editorial: Approach to management “should incorporate facts and values” and parental discretion, and the facts suggest that treatment is not "clearly in the infants' best interests and thus is not ethically obligatory."

Key results

  • 49.3% of infants received active treatment.
  • 12.7% overall survived to discharge; 25.7% of actively treated infants survived to discharge.
  • Survival among infants not receiving active treatment was zero.
  • Almost all deaths were within 12 hours of birth.
  • 21% of actively treated infants survived to toddler age.
  • 74% of survivors had moderate-severe neurodevelopmental impairments, multiple morbidities at 18-26 months of chronological age.

Study design

  • Retrospective, multicenter cohort study, 205 infants
  • Active treatment: any potentially lifesaving intervention postdelivery.
  • Outcomes: survival, neurodevelopmental impairment.
  • Funding: Eunice Kennedy Shriver National Institute of Child Health and Human Development, others.

Limitations

  • No standardized criteria for applying active treatment.
  • 2-year follow-up falls short of window for identifying some neurodevelopmental conditions.