IMPORTANCE Despite improvement during recent decades, extremely preterm infants continue to contribute disproportionately to neonatal mortality and childhood morbidity. OBJECTIVE To review survival, in-hospital morbidities, care practices, and neurodevelopmental and functional outcomes at 22-26 months' corrected age for extremely preterm infants. DESIGN, SETTING, AND PARTICIPANTS Prospective registry for extremely preterm infants born at 19 US academic centers that are part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. The study included 10 877 infants born at 22-28 weeks' gestational age between January 1, 2013, and December 31, 2018, including 2566 infants born before 27 weeks between January 1, 2013, and December 31, 2016, who completed follow-up assessments at 22-26 months' corrected age. The last assessment was completed on August 13, 2019. Outcomes were compared with a similar cohort of infants born in 2008-2012 adjusting for gestational age. EXPOSURES Extremely preterm birth. MAIN OUTCOMES AND MEASURES Survival and 12 in-hospital morbidities were assessed, including necrotizing enterocolitis, infection, intracranial hemorrhage, retinopathy of prematurity, and bronchopulmonary dysplasia. Infants were assessed at 22-26 months' corrected age for 12 health and functional outcomes, including neurodevelopment, cerebral palsy, vision, hearing, rehospitalizations, and need for assistive devices. RESULTS The 10 877 infants were 49.0% female and 51.0% male; 78.3% (8495/10848) survived to discharge, an increase from 76.0% in 2008-2012 (adjusted difference, 2.0%; 95% CI, 1.0%-2.9%). Survival to discharge was 10.9% (60/549) for live-born infants at 22 weeks and 94.0% (2267/2412) at 28 weeks. Survival among actively treated infants was 30.0% (60/200) at 22 weeks and 55.8% (535/958) at 23 weeks. All in-hospital morbidities were more likely among infants born at earlier gestational ages. Overall, 8.9% (890/9956) of infants had necrotizing enterocolitis, 2.4% (238/9957) had early-onset infection, 19.9% (1911/9610) had late-onset infection, 14.3% (1386/9705) had severe intracranial hemorrhage, 12.8% (1099/8585) had severe retinopathy of prematurity, and 8.0% (666/8305) had severe bronchopulmonary dysplasia. Among 2930 surviving infants with gestational ages of 22-26 weeks eligible for follow-up, 2566 (87.6%) were examined. By 2-year follow-up, 8.4% (214/2555) of children had moderate to severe cerebral palsy, 1.5% (38/2555) had bilateral blindness, 2.5% (64/2527) required hearing aids or cochlear implants, 49.9% (1277/2561) had been rehospitalized, and 15.4% (393/2560) required mobility aids or other supportive devices. Among 2458 fully evaluated infants, 48.7% (1198/2458) had no or mild neurodevelopmental impairment at follow-up, 29.3% (709/2419) had moderate neurodevelopmental impairment, and 21.2% (512/2419) had severe neurodevelopmental impairment. CONCLUSIONS AND RELEVANCE Among extremely preterm infants born in 2013-2018 and treated at 19 US academic medical centers, 78.3% survived to discharge, a significantly higher rate than for infants born in 2008-2012. Among infants born at less than 27 weeks' gestational age, rehospitalization and neurodevelopmental impairment were common at 2 years of age.

中文翻译：

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2013-2018 年美国极早产儿的死亡率、院内发病率、护理实践和 2 年结果。


重要性 尽管近几十年来情况有所改善，但极早产儿仍然对新生儿死亡率和儿童发病率造成不成比例的影响。目的 回顾极早产儿 22-26 个月校正年龄时的生存率、院内发病率、护理实践以及神经发育和功能结果。设计、设置和参与者 对在 19 个美国学术中心出生的极早产儿进行前瞻性登记，这些中心是尤尼斯·肯尼迪·施赖弗国家儿童健康和人类发展研究所新生儿研究网络的一部分。该研究纳入了2013年1月1日至2018年12月31日期间出生的10877名22-28周胎龄婴儿，其中包括2013年1月1日至2016年12月31日期间27周之前出生的2566名婴儿，他们完成了以下研究：在 22-26 个月的校正年龄时进行评估。最后一次评估于 2019 年 8 月 13 日完成。结果与 2008-2012 年出生的类似婴儿队列进行比较，并调整胎龄。暴露 极度早产。主要结果和措施评估了生存率和 12 种院内发病率，包括坏死性小肠结肠炎、感染、颅内出血、早产儿视网膜病变和支气管肺发育不良。婴儿在 22-26 个月的校正年龄时接受了 12 项健康和功能结果的评估，包括神经发育、脑瘫、视力、听力、再住院和辅助设备的需要。结果 10 877例婴儿中，女性占49.0%，男性占51.0%； 78.3% (8495/10848) 存活出院，比 2008-2012 年的 76.0% 有所增加（调整后差异，2.0%；95% CI，1.0%-2.9%）。 22 周时的活产婴儿出院存活率为 10.9% (60/549)，28 周时的存活率为 94.0% (2267/2412)。 积极治疗的婴儿在 22 周时的存活率为 30.0% (60/200)，在 23 周时的存活率为 55.8% (535/958)。所有院内发病率在较早胎龄出生的婴儿中更有可能发生。总体而言，8.9% (890/9956) 的婴儿患有坏死性小肠结肠炎，2.4% (238/9957) 患有早发感染，19.9% (1911/9610) 患有晚发感染，14.3% (1386/9705) 患有严重感染颅内出血，12.8%（1099/8585）有严重早产儿视网膜病变，8.0%（666/8305）有严重支气管肺发育不良。在 2930 名符合随访条件的胎龄 22-26 周的存活婴儿中，有 2566 名（87.6%）接受了检查。截至 2 年随访，8.4% (214/2555) 的儿童患有中度至重度脑瘫，1.5% (38/2555) 患有双侧失明，2.5% (64/2527) 需要助听器或人工耳蜗植入，49.9% % (1277/2561) 已再次住院，15.4% (393/2560) 需要行动辅助器具或其他支持装置。在 2458 名经过全面评估的婴儿中，48.7%（1198/2458）在随访时没有或轻度神经发育障碍，29.3%（709/2419）有中度神经发育障碍，21.2%（512/2419）有严重神经发育障碍。结论和相关性 在 2013-2018 年出生并在 19 个美国学术医疗中心接受治疗的极度早产儿中，78.3% 存活出院，显着高于 2008-2012 年出生的婴儿。在胎龄小于 27 周的婴儿中，2 岁时再住院和神经发育障碍很常见。