Original Article
Extremely Low Birthweight Neonates with Protracted Ventilation: Mortality and 18-Month Neurodevelopmental Outcomes

https://doi.org/10.1016/j.jpeds.2005.01.047Get rights and content

Objective

To compare duration of ventilation to mortality and adverse neurodevelopmental outcomes among extremely low birth weight (ELBW; 501-1000 g) infants.

Study design

Retrospective analysis of prospectively collected data from 5364 infants with a birthweight of 501 to 1000 g born at National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers from 1995 to 1998. The main outcome measures were: survival, duration of mechanical ventilation, and neurodevelopmental outcome.

Results

Overall survival was 71%. The median duration of ventilation for survivors was 23 days; 75% were free of mechanical ventilation by 39 days, and 7% were ventilated for ≥60 days. Of those ventilated for ≥60 days, 24% survived without impairment. Of those ventilated for ≥90 days, only 7% survived without impairment. Of those ventilated ≥120 days, all survivors were impaired.

Conclusions

The prognosis for ELBW with protracted ventilation remains grim. The cohort who remain intubated have diminished survival and high rates of impairment. Parents of these infants should be informed of changes in prognosis as the time of ventilation increases.

Section snippets

Methods

This study was a retrospective analysis of data prospectively collected at the 15 participating centers of the National Institute of Child Health and Human Development (NICHD) Neonatal Research Network. Collected data described the characteristics of the pregnancy and deliveries of 5364 live born ELBW neonates between January 1995 and December 1998. Detailed data on treatments, including duration of mechanical ventilation, were collected using standardized protocols and pre-coded forms from

Population

Of 5364 live born infants, 3782 survived to hospital discharge; 82 neonates died after initial hospital discharge but before 18 months of age, and 659 were lost to follow-up. Thus, 3041(80%) of the 3782 infants who survived to discharge were evaluated for outcomes (Figure 1). Neonates were born at a weight of 766 ± 140 g (mean ± standard deviation), 25.8 ± 2.2 weeks postmenstrual age, were 50.1% male, and 43.8% African American. The mother's age at delivery was 26.6 ± 6.9 years (mean ± standard

Discussion

This study summarizes the findings for a large heterogeneous and contemporary group of ELBW infants cared for at 15 centers and relates their survival and neurodevelopmental outcomes at 18 to 22 months of age to their respiratory course in the neonatal period. These tiny infants have been the focus of the frontier of neonatal care. Seventy-five percent of ELBW infants in this cohort who survived were ventilated for a cumulative total of ≤39 days. The 25% of ELBW infants who remain ventilated

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