Differing Hospital Practices May Affect Survival Rates Among Extremely Premature Infants

The largest study of data to date on premature infants and postnatal care measures shows that between-hospital variation in outcomes among extremely preterm infants could reflect differences in hospital practices—the difference between giving active, lifesaving treatment rather than comfort care after birth. The authors of the New England Journal of Medicine study published May 7, 2015, found that the differences in care may largely elucidate the varying survival rates between hospitals and partially explain the substantial but smaller variation in survival among those infants with no neurodevelopmental impairment.

A total of 4,987 infants born at 24 hospitals in the research network between April 1, 2006, and March 31, 2011, were included in the study. Among the infants who received active treatment, 9% of those born at 22 weeks of gestation survived without moderate or severe impairment. No babies born at 21 weeks survived in spite of any treatment they received.

Duke neonatologists Michael Cotten, MD, and Brian Smith, MD, were co-authors of the study group, the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. “It’s still a challenging road for lowest-gestational-age babies and a struggle about what to do; more hospitals want to include families in those discussions,” Dr. Cotten says. “We are not sure whether or how we might change our own practices based on the data here, which should open discussions at other hospitals and with family members.”

A New York Times article about the study noted that infants born between 22 and 23 weeks have a low likelihood of survival, but variables such as birth weight and prenatal care with corticosteroids can help lung and brain development in these infants. Cotten adds that babies born at 22 weeks also have a high likelihood of severe impairment, acquired morbidities and infections, brain bleeds, and intestinal problems.

Dr. Smith is a published researcher who has studied the effectiveness of steroid administration in mothers at risk of giving birth prematurely. “While there is still much debate about what to do for the most premature infants, there is a positive message we can send to obstetricians,” notes Smith. “We know that a National Institutes of Health consensus statement recommends antenatal steroids between 24 and 34 weeks for mothers at risk of premature birth. It helps, so I think encouraging their use even at 23 weeks would be a good practice for us to adopt.”