Online Calculator to Improve Counseling of Short-Term Neonatal Morbidity and Mortality Outcomes at Extremely Low Gestational Age (23–28 Weeks)

Abstract

Objective Extremely low gestational age (ELGA) infants are at high risk of perinatal and neonatal morbidity and mortality. Accurate and relevant data are essential for developing a health care plan and providing realistic estimates of infants' outcomes.

Study Design Retrospective analysis of all infants delivered between 23^0/7 and 28^6/7 weeks' gestation over 11 years at a single center. Using logistic regression analysis, gestational age (GA)-specific mortality and morbidity rates, and the effects of gender, antenatal corticosteroids, multiple gestation, and birth weight (BW) were determined.

Results Of the 766 study infants, 644 (84.1%) were admitted to the neonatal intensive care unit, of which 502 (75.8%) survived to discharge. GA, antenatal corticosteroids, and BW were significant predictors of survival (GA: odds ratio [OR] = 1.83, 95% confidence interval [CI] = 1.64–2.04; corticosteroids: OR = 7.62, 95% CI = 5.19–11.18; BW: OR = 1.56, 95% CI = 1.44–1.69). Increasing BW correlated with a decreasing mortality rate.

Conclusion This study provides recent outcome data of ELGA infants delivered at a tertiary level center. The results have been translated into an online counseling tool (http://murmuring-brook-6600.herokuapp.com/ELGA.html).

Keywords

extremely low gestational age - survival - morbidity - counseling

• References

• 1 Hummler H. Benchmarking in neonatal intensive care: obstetrical and neonatal practices and registration policies may influence outcome data. Arch Dis Child Fetal Neonatal Ed 2013; 98 (2) F96-F97
• 2 Stoll BJ, Hansen NI, Bell EF , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (3) 443-456
• 3 Chan KL, Kean LH, Marlow N. Staff views on the management of the extremely preterm infant. Eur J Obstet Gynecol Reprod Biol 2006; 128 (1–2) 142-147
• 4 Jefferies AL, Kirpalani HM ; Canadian Paediatric Society Fetus and Newborn Committee. Counselling and management for anticipated extremely preterm birth. Paediatr Child Health (Oxford) 2012; 17 (8) 443-446
• 5 Young E, Tsai E, O'Riordan A. A qualitative study of predelivery counselling for extreme prematurity. Paediatr Child Health (Oxford) 2012; 17 (8) 432-436
• 6 Mongelli M, Wilcox M, Gardosi J. Estimating the date of confinement: ultrasonographic biometry versus certain menstrual dates. Am J Obstet Gynecol 1996; 174 (1 Pt 1): 278-281
• 7 Shah PS, Ye XY, Synnes A, Rouvinez-Bouali N, Yee W, Lee SK ; Canadian Neonatal Network. Prediction of survival without morbidity for infants born at under 33 weeks gestational age: a user-friendly graphical tool. Arch Dis Child Fetal Neonatal Ed 2012; 97 (2) F110-F115
• 8 Synnes AR, Ling EWY, Whitfield MF , et al. Perinatal outcomes of a large cohort of extremely low gestational age infants (twenty-three to twenty-eight completed weeks of gestation). J Pediatr 1994; 125 (6 Pt 1): 952-960
• 9 Schlapbach LJ, Adams M, Proietti E , et al; Swiss Neonatal Network & Follow-up Group. Outcome at two years of age in a Swiss national cohort of extremely preterm infants born between 2000 and 2008. BMC Pediatr 2012; 12: 198
• 10 Tyson JE, Parikh NA, Langer J, Green C, Higgins RD ; National Institute of Child Health and Human Development Neonatal Research Network. Intensive care for extreme prematurity—moving beyond gestational age. N Engl J Med 2008; 358 (16) 1672-1681
• 11 Schmidt B, Asztalos EV, Roberts RS, Robertson CMT, Sauve RS, Whitfield MF ; Trial of Indomethacin Prophylaxis in Preterms (TIPP) Investigators. Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms. JAMA 2003; 289 (9) 1124-1129
• 12 Herber-Jonat S, Streiftau S, Knauss E , et al. Long-term outcome at age 7-10 years after extreme prematurity - a prospective, two centre cohort study of children born before 25 completed weeks of gestation (1999-2003). J Matern Fetal Neonatal Med 2014; 27 (16) 1620-1626
• 13 Bassler D, Stoll BJ, Schmidt B , et al; Trial of Indomethacin Prophylaxis in Preterms Investigators. Using a count of neonatal morbidities to predict poor outcome in extremely low birth weight infants: added role of neonatal infection. Pediatrics 2009; 123 (1) 313-318
• 14 Hintz SR, Kendrick DE, Stoll BJ , et al; NICHD Neonatal Research Network. Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotizing enterocolitis. Pediatrics 2005; 115 (3) 696-703
• 15 Schulzke SM, Deshpande GC, Patole SK. Neurodevelopmental outcomes of very low-birth-weight infants with necrotizing enterocolitis: a systematic review of observational studies. Arch Pediatr Adolesc Med 2007; 161 (6) 583-590
• 16 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4) 529-534
• 17 International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol 2005; 123 (7) 991-999
• 18 Bell MJ, Ternberg JL, Feigin RD , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (1) 1-7
• 19 Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 1988; 82 (4) 527-532
• 20 Behrman RE, Butler AS. Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: The National Academies Press; 2007
• 21 Edmonds BT, McKenzie F, Hendrix KS, Perkins SM, Zimet GD. The influence of resuscitation preferences on obstetrical management of periviable deliveries. J Perinatol 2015; 35 (3) 161-166
• 22 Carlo WA, McDonald SA, Fanaroff AA , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation. JAMA 2011; 306 (21) 2348-2358
• 23 Crane J, Armson A, Brunner M , et al; Executive Committee of the Society of Obstetricians and Gynaecologists of Canada. Antenatal corticosteroid therapy for fetal maturation. J Obstet Gynaecol Can 2003; 25 (1) 45-52
• 24 Wong D, Abdel-Latif M, Kent A ; NICUS Network. Antenatal steroid exposure and outcomes of very premature infants: a regional cohort study. Arch Dis Child Fetal Neonatal Ed 2014; 99 (1) F12-F20
• 25 Chawla S, Bapat R, Pappas A, Bara R, Zidan M, Natarajan G. Neurodevelopmental outcome of extremely premature infants exposed to incomplete, no or complete antenatal steroids. J Matern Fetal Neonatal Med 2013; 26 (15) 1542-1547
• 26 Costa S, Zecca E, De Luca D, De Carolis MP, Romagnoli C. Efficacy of a single dose of antenatal corticosteroids on morbidity and mortality of preterm infants. Eur J Obstet Gynecol Reprod Biol 2007; 131 (2) 154-157
• 27 Elimian A, Figueroa R, Spitzer AR, Ogburn PL, Wiencek V, Quirk JG. Antenatal corticosteroids: are incomplete courses beneficial?. Obstet Gynecol 2003; 102 (2) 352-355
• 28 Grisaru-Granovsky S, Reichman B, Lerner-Geva L , et al; Israel Neonatal Network. Mortality and morbidity in preterm small-for-gestational-age infants: a population-based study. Am J Obstet Gynecol 2012; 206 (2) 150.e1-150.e7
• 29 Regev RH, Lusky A, Dolfin T, Litmanovitz I, Arnon S, Reichman B ; Israel Neonatal Network. Excess mortality and morbidity among small-for-gestational-age premature infants: a population-based study. J Pediatr 2003; 143 (2) 186-191
• 30 de Waal CG, Weisglas-Kuperus N, van Goudoever JB, Walther FJ ; NeoNed Study Group; LNF Study Group. Mortality, neonatal morbidity and two year follow-up of extremely preterm infants born in The Netherlands in 2007. PLoS ONE 2012; 7 (7) e41302
• 31 Ge WJ, Mirea L, Yang J, Bassil KL, Lee SK, Shah PS ; Canadian Neonatal Network. Prediction of neonatal outcomes in extremely preterm neonates. Pediatrics 2013; 132 (4) e876-e885
• 32 Eunice Kennedy Shriver National Institute of Child Health and Human Development. NICHD Neonatal Research Network (NRN): Extremely Preterm Birth Outcome Data. Bethesda, Maryland: NICHD; 2012. Available at: http://www.nichd.nih.gov/about/org/der/branches/ppb/programs/epbo/Pages/epbo_case.aspx . Accessed February 8, 2014
• 33 Chan K, Ohlsson A, Synnes A, Lee DSC, Chien L-Y, Lee SK ; Canadian Neonatal Network. Survival, morbidity, and resource use of infants of 25 weeks' gestational age or less. Am J Obstet Gynecol 2001; 185 (1) 220-226
• 34 Kugelman A, Bader D, Lerner-Geva L , et al. Poor outcomes at discharge among extremely premature infants: a national population-based study. Arch Pediatr Adolesc Med 2012; 166 (6) 543-550
• 35 Magee L, Sawchuk D, Synnes A, von Dadelszen P. SOGC Clinical Practice Guideline. Magnesium sulphate for fetal neuroprotection. J ObstetGynaecol Can 2011; 33 (5) 516-529