Neonatal outcomes of moderately preterm infants compared to extremely preterm infants

• Authors: Michele C. Walsh, Case Western Reserve University; Edward F. Bell, University of Iowa; Sarah Kandefer, RTI International; Shampa Saha, RTI International; Waldemar A. Carlo, University of Alabama Birmingham; Carl T. D'angio, University of Rochester; Abbot R. Laptook, Brown University; Pablo J. Sanchez, Nationwide Children’s Hospital; Barbara Stoll, Emory University; Seetha Shankaran, Wayne State University; Krisa P. Van Meurs, Stanford University; Noah Cook, The Children’s Hospital of Philadelphia; Rosemary D. Higgins, National Institutes of Health; Abhik Das, RTI International; Nancy Newman, Emory University; Kurt Schibler, Cincinnati Children’s Hospital; Barbara Schmidt, The Children’s Hospital of Philadelphia; C. Michael Cotten, Duke University; Brenda B. Poindexter, Cincinnati Children’s Hospital; Kristi L. Watterberg, University of New Mexico; William E. Truog, Children’s Mercy Hospital
• Journal Title: Pediatric Research
• Volume: Volume 82, Number 2
• Publisher: Nature Publishing Group: Open Access Hybrid Model Option A | 2017-08-01, Pages 297-304
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1038/pr.2017.46
• Subjects: Health Sciences, Obstetrics and Gynecology; Health Sciences, General
• Keywords: Science & Technology; Life Sciences & Biomedicine; Pediatrics; LUNG-FUNCTION; BIRTH; MORBIDITY; ADULTS; CARE

Abstract

BackgroundExtremely preterm infants (EPT, < 29 weeks' gestation) represent only 0.9% of births in the United States; yet these infants are the focus of most published research. Moderately preterm neonates (MPT, 29-33 6/7 weeks) are an understudied group of high-risk infants.MethodsTo determine the neonatal outcomes of MPT infants across the gestational age spectrum, and to compare these with EPT infants. A prospective observational cohort was formed in 18 level 3-4 neonatal intensive care units (NICUs) in the Eunice Kennedy Shriver NICHD Neonatal Research Network. Participants included all MPT infants admitted to NICUs and all EPT infants born at sites between January 2012 and November 2013. Antenatal characteristics and neonatal morbidities were abstracted from records using pre-specified definitions by trained neonatal research nurses.ResultsMPT infants experienced morbidities similar to, although at lower rates than, those of EPT infants. The main cause of mortality was congenital malformation, accounting for 43% of deaths. Central Nervous System injury occurred, including intraventricular hemorrhage. Most MPT infants required respiratory support, but sequelae such as bronchopulmonary dysplasia were rare. The primary contributors to hospitalization beyond 36 weeks' gestation were inability to achieve adequate oral intake and persistent apnea.ConclusionsMPT infants experience morbidity and prolonged hospitalization. Such morbidity deserves focused research to improve therapeutic and prevention strategies.