Preterm neonatal morbidity and mortality by gestational age

A contemporary cohort

Tracy A. Manuck, Madeline Murguia Rice, Jennifer L. Bailit, William A. Grobman, Uma M. Reddy, Ronald J. Wapner, John M. Thorp, Steve N. Caritis, Mona Prasad, Alan T N Tita, George R. Saade, Yoram Sorokin, Dwight J. Rouse, Sean C. Blackwell, Jorge E. Tolosa, M. Varner, K. Hill, A. Sowles, J. Postma, S. Alexander & 128 others G. Andersen, V. Scott, V. Morby, K. Jolley, J. Miller, B. Berg, M. Talucci, M. Zylfijaj, Z. Reid, R. Leed, J. Benson, S. Forester, C. Kitto, S. Davis, M. Falk, C. Perez, K. Dorman, J. Mitchell, E. Kaluta, K. Clark, K. Spicer, S. Timlin, K. Wilson, K. Leveno, L. Moseley, M. Santillan, J. Price, K. Buentipo, V. Bludau, T. Thomas, L. Fay, C. Melton, J. Kingsbery, R. Benezue, H. Simhan, M. Bickus, D. Fischer, T. Kamon, D. Deangelis, B. Mercer, C. Milluzzi, W. Dalton, T. Dotson, P. McDonald, C. Brezine, A. McGrail, C. Latimer, L. Guzzo, F. Johnson, L. Gerwig, S. Fyffe, D. Loux, S. Frantz, D. Cline, S. Wylie, J. Iams, M. Wallace, A. Northen, J. Grant, C. Colquitt, D. Rouse, W. Andrews, G. Mallett, M. Ramos-Brinson, A. Roy, L. Stein, P. Campbell, C. Collins, N. Jackson, M. Dinsmoor, J. Senka, K. Paychek, A. Peaceman, J. Moss, A. Salazar, A. Acosta, G. Hankins, N. Hauff, L. Palmer, P. Lockhart, D. Driscoll, L. Wynn, C. Sudz, D. Dengate, C. Girard, S. Field, P. Breault, F. Smith, N. Annunziata, D. Allard, J. Silva, M. Gamage, J. Hunt, J. Tillinghast, N. Corcoran, M. Jimenez, F. Ortiz, P. Givens, B. Rech, C. Moran, M. Hutchinson, Z. Spears, C. Carreno, B. Heaps, G. Zamora, J. Seguin, M. Rincon, J. Snyder, C. Farrar, E. Lairson, C. Bonino, W. Smith, K. Beach, S. Van Dyke, S. Butcher, E. Thom, Y. Zhao, P. McGee, V. Momirova, R. Palugod, B. Reamer, M. Larsen, T. Williams, T. Spangler, A. Lozitska, C. Spong, S. Tolivaisa, J. P. Vandorsten

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Background Although preterm birth <37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates. Objective We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages. Study Design This was a secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008 through 2011. All liveborn nonanomalous singleton preterm (23.0-36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade I/II, necrotizing enterocolitis stage I, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome for which criteria was met. Results In all, 8334 deliveries met inclusion criteria. There were 119 (1.4%) neonatal deaths. In all, 657 (7.9%) neonates had major morbidity, 3136 (37.6%) had minor morbidity, and 4422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25 weeks of gestation. As frequencies of death and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31 weeks of gestation. The frequency of all morbidities fell >32 weeks. After 25 weeks, neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26-32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median postmenstrual age at discharge nadired around 36 weeks' postmenstrual age for babies born at 31-35 weeks of gestation. Conclusion Our data show that there is a continuum of outcomes, with each additional week of gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.

Original languageEnglish (US)
Pages (from-to)103.e1-103.e14
JournalAmerican Journal of Obstetrics and Gynecology
Volume215
Issue number1
DOIs
StatePublished - Jul 1 2016

Fingerprint

Infant Mortality
Gestational Age
Morbidity
Pregnancy
Length of Stay
Hospitalization
Premature Birth
Counseling
Survival

Keywords

  • neonatal morbidity
  • neonatal mortality
  • prematurity

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Manuck, T. A., Rice, M. M., Bailit, J. L., Grobman, W. A., Reddy, U. M., Wapner, R. J., ... Vandorsten, J. P. (2016). Preterm neonatal morbidity and mortality by gestational age: A contemporary cohort. American Journal of Obstetrics and Gynecology, 215(1), 103.e1-103.e14. https://doi.org/10.1016/j.ajog.2016.01.004

Preterm neonatal morbidity and mortality by gestational age : A contemporary cohort. / Manuck, Tracy A.; Rice, Madeline Murguia; Bailit, Jennifer L.; Grobman, William A.; Reddy, Uma M.; Wapner, Ronald J.; Thorp, John M.; Caritis, Steve N.; Prasad, Mona; Tita, Alan T N; Saade, George R.; Sorokin, Yoram; Rouse, Dwight J.; Blackwell, Sean C.; Tolosa, Jorge E.; Varner, M.; Hill, K.; Sowles, A.; Postma, J.; Alexander, S.; Andersen, G.; Scott, V.; Morby, V.; Jolley, K.; Miller, J.; Berg, B.; Talucci, M.; Zylfijaj, M.; Reid, Z.; Leed, R.; Benson, J.; Forester, S.; Kitto, C.; Davis, S.; Falk, M.; Perez, C.; Dorman, K.; Mitchell, J.; Kaluta, E.; Clark, K.; Spicer, K.; Timlin, S.; Wilson, K.; Leveno, K.; Moseley, L.; Santillan, M.; Price, J.; Buentipo, K.; Bludau, V.; Thomas, T.; Fay, L.; Melton, C.; Kingsbery, J.; Benezue, R.; Simhan, H.; Bickus, M.; Fischer, D.; Kamon, T.; Deangelis, D.; Mercer, B.; Milluzzi, C.; Dalton, W.; Dotson, T.; McDonald, P.; Brezine, C.; McGrail, A.; Latimer, C.; Guzzo, L.; Johnson, F.; Gerwig, L.; Fyffe, S.; Loux, D.; Frantz, S.; Cline, D.; Wylie, S.; Iams, J.; Wallace, M.; Northen, A.; Grant, J.; Colquitt, C.; Rouse, D.; Andrews, W.; Mallett, G.; Ramos-Brinson, M.; Roy, A.; Stein, L.; Campbell, P.; Collins, C.; Jackson, N.; Dinsmoor, M.; Senka, J.; Paychek, K.; Peaceman, A.; Moss, J.; Salazar, A.; Acosta, A.; Hankins, G.; Hauff, N.; Palmer, L.; Lockhart, P.; Driscoll, D.; Wynn, L.; Sudz, C.; Dengate, D.; Girard, C.; Field, S.; Breault, P.; Smith, F.; Annunziata, N.; Allard, D.; Silva, J.; Gamage, M.; Hunt, J.; Tillinghast, J.; Corcoran, N.; Jimenez, M.; Ortiz, F.; Givens, P.; Rech, B.; Moran, C.; Hutchinson, M.; Spears, Z.; Carreno, C.; Heaps, B.; Zamora, G.; Seguin, J.; Rincon, M.; Snyder, J.; Farrar, C.; Lairson, E.; Bonino, C.; Smith, W.; Beach, K.; Van Dyke, S.; Butcher, S.; Thom, E.; Zhao, Y.; McGee, P.; Momirova, V.; Palugod, R.; Reamer, B.; Larsen, M.; Williams, T.; Spangler, T.; Lozitska, A.; Spong, C.; Tolivaisa, S.; Vandorsten, J. P.

In: American Journal of Obstetrics and Gynecology, Vol. 215, No. 1, 01.07.2016, p. 103.e1-103.e14.

Research output: Contribution to journalArticle

Manuck, TA, Rice, MM, Bailit, JL, Grobman, WA, Reddy, UM, Wapner, RJ, Thorp, JM, Caritis, SN, Prasad, M, Tita, ATN, Saade, GR, Sorokin, Y, Rouse, DJ, Blackwell, SC, Tolosa, JE, Varner, M, Hill, K, Sowles, A, Postma, J, Alexander, S, Andersen, G, Scott, V, Morby, V, Jolley, K, Miller, J, Berg, B, Talucci, M, Zylfijaj, M, Reid, Z, Leed, R, Benson, J, Forester, S, Kitto, C, Davis, S, Falk, M, Perez, C, Dorman, K, Mitchell, J, Kaluta, E, Clark, K, Spicer, K, Timlin, S, Wilson, K, Leveno, K, Moseley, L, Santillan, M, Price, J, Buentipo, K, Bludau, V, Thomas, T, Fay, L, Melton, C, Kingsbery, J, Benezue, R, Simhan, H, Bickus, M, Fischer, D, Kamon, T, Deangelis, D, Mercer, B, Milluzzi, C, Dalton, W, Dotson, T, McDonald, P, Brezine, C, McGrail, A, Latimer, C, Guzzo, L, Johnson, F, Gerwig, L, Fyffe, S, Loux, D, Frantz, S, Cline, D, Wylie, S, Iams, J, Wallace, M, Northen, A, Grant, J, Colquitt, C, Rouse, D, Andrews, W, Mallett, G, Ramos-Brinson, M, Roy, A, Stein, L, Campbell, P, Collins, C, Jackson, N, Dinsmoor, M, Senka, J, Paychek, K, Peaceman, A, Moss, J, Salazar, A, Acosta, A, Hankins, G, Hauff, N, Palmer, L, Lockhart, P, Driscoll, D, Wynn, L, Sudz, C, Dengate, D, Girard, C, Field, S, Breault, P, Smith, F, Annunziata, N, Allard, D, Silva, J, Gamage, M, Hunt, J, Tillinghast, J, Corcoran, N, Jimenez, M, Ortiz, F, Givens, P, Rech, B, Moran, C, Hutchinson, M, Spears, Z, Carreno, C, Heaps, B, Zamora, G, Seguin, J, Rincon, M, Snyder, J, Farrar, C, Lairson, E, Bonino, C, Smith, W, Beach, K, Van Dyke, S, Butcher, S, Thom, E, Zhao, Y, McGee, P, Momirova, V, Palugod, R, Reamer, B, Larsen, M, Williams, T, Spangler, T, Lozitska, A, Spong, C, Tolivaisa, S & Vandorsten, JP 2016, 'Preterm neonatal morbidity and mortality by gestational age: A contemporary cohort', American Journal of Obstetrics and Gynecology, vol. 215, no. 1, pp. 103.e1-103.e14. https://doi.org/10.1016/j.ajog.2016.01.004
Manuck, Tracy A. ; Rice, Madeline Murguia ; Bailit, Jennifer L. ; Grobman, William A. ; Reddy, Uma M. ; Wapner, Ronald J. ; Thorp, John M. ; Caritis, Steve N. ; Prasad, Mona ; Tita, Alan T N ; Saade, George R. ; Sorokin, Yoram ; Rouse, Dwight J. ; Blackwell, Sean C. ; Tolosa, Jorge E. ; Varner, M. ; Hill, K. ; Sowles, A. ; Postma, J. ; Alexander, S. ; Andersen, G. ; Scott, V. ; Morby, V. ; Jolley, K. ; Miller, J. ; Berg, B. ; Talucci, M. ; Zylfijaj, M. ; Reid, Z. ; Leed, R. ; Benson, J. ; Forester, S. ; Kitto, C. ; Davis, S. ; Falk, M. ; Perez, C. ; Dorman, K. ; Mitchell, J. ; Kaluta, E. ; Clark, K. ; Spicer, K. ; Timlin, S. ; Wilson, K. ; Leveno, K. ; Moseley, L. ; Santillan, M. ; Price, J. ; Buentipo, K. ; Bludau, V. ; Thomas, T. ; Fay, L. ; Melton, C. ; Kingsbery, J. ; Benezue, R. ; Simhan, H. ; Bickus, M. ; Fischer, D. ; Kamon, T. ; Deangelis, D. ; Mercer, B. ; Milluzzi, C. ; Dalton, W. ; Dotson, T. ; McDonald, P. ; Brezine, C. ; McGrail, A. ; Latimer, C. ; Guzzo, L. ; Johnson, F. ; Gerwig, L. ; Fyffe, S. ; Loux, D. ; Frantz, S. ; Cline, D. ; Wylie, S. ; Iams, J. ; Wallace, M. ; Northen, A. ; Grant, J. ; Colquitt, C. ; Rouse, D. ; Andrews, W. ; Mallett, G. ; Ramos-Brinson, M. ; Roy, A. ; Stein, L. ; Campbell, P. ; Collins, C. ; Jackson, N. ; Dinsmoor, M. ; Senka, J. ; Paychek, K. ; Peaceman, A. ; Moss, J. ; Salazar, A. ; Acosta, A. ; Hankins, G. ; Hauff, N. ; Palmer, L. ; Lockhart, P. ; Driscoll, D. ; Wynn, L. ; Sudz, C. ; Dengate, D. ; Girard, C. ; Field, S. ; Breault, P. ; Smith, F. ; Annunziata, N. ; Allard, D. ; Silva, J. ; Gamage, M. ; Hunt, J. ; Tillinghast, J. ; Corcoran, N. ; Jimenez, M. ; Ortiz, F. ; Givens, P. ; Rech, B. ; Moran, C. ; Hutchinson, M. ; Spears, Z. ; Carreno, C. ; Heaps, B. ; Zamora, G. ; Seguin, J. ; Rincon, M. ; Snyder, J. ; Farrar, C. ; Lairson, E. ; Bonino, C. ; Smith, W. ; Beach, K. ; Van Dyke, S. ; Butcher, S. ; Thom, E. ; Zhao, Y. ; McGee, P. ; Momirova, V. ; Palugod, R. ; Reamer, B. ; Larsen, M. ; Williams, T. ; Spangler, T. ; Lozitska, A. ; Spong, C. ; Tolivaisa, S. ; Vandorsten, J. P. / Preterm neonatal morbidity and mortality by gestational age : A contemporary cohort. In: American Journal of Obstetrics and Gynecology. 2016 ; Vol. 215, No. 1. pp. 103.e1-103.e14.
@article{8e49a82ce2fc434fab6eb014c3256186,
title = "Preterm neonatal morbidity and mortality by gestational age: A contemporary cohort",
abstract = "Background Although preterm birth <37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates. Objective We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages. Study Design This was a secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008 through 2011. All liveborn nonanomalous singleton preterm (23.0-36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade I/II, necrotizing enterocolitis stage I, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome for which criteria was met. Results In all, 8334 deliveries met inclusion criteria. There were 119 (1.4{\%}) neonatal deaths. In all, 657 (7.9{\%}) neonates had major morbidity, 3136 (37.6{\%}) had minor morbidity, and 4422 (53.1{\%}) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8{\%} at 25 weeks of gestation. As frequencies of death and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7{\%} at 31 weeks of gestation. The frequency of all morbidities fell >32 weeks. After 25 weeks, neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26-32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median postmenstrual age at discharge nadired around 36 weeks' postmenstrual age for babies born at 31-35 weeks of gestation. Conclusion Our data show that there is a continuum of outcomes, with each additional week of gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.",
keywords = "neonatal morbidity, neonatal mortality, prematurity",
author = "Manuck, {Tracy A.} and Rice, {Madeline Murguia} and Bailit, {Jennifer L.} and Grobman, {William A.} and Reddy, {Uma M.} and Wapner, {Ronald J.} and Thorp, {John M.} and Caritis, {Steve N.} and Mona Prasad and Tita, {Alan T N} and Saade, {George R.} and Yoram Sorokin and Rouse, {Dwight J.} and Blackwell, {Sean C.} and Tolosa, {Jorge E.} and M. Varner and K. Hill and A. Sowles and J. Postma and S. Alexander and G. Andersen and V. Scott and V. Morby and K. Jolley and J. Miller and B. Berg and M. Talucci and M. Zylfijaj and Z. Reid and R. Leed and J. Benson and S. Forester and C. Kitto and S. Davis and M. Falk and C. Perez and K. Dorman and J. Mitchell and E. Kaluta and K. Clark and K. Spicer and S. Timlin and K. Wilson and K. Leveno and L. Moseley and M. Santillan and J. Price and K. Buentipo and V. Bludau and T. Thomas and L. Fay and C. Melton and J. Kingsbery and R. Benezue and H. Simhan and M. Bickus and D. Fischer and T. Kamon and D. Deangelis and B. Mercer and C. Milluzzi and W. Dalton and T. Dotson and P. McDonald and C. Brezine and A. McGrail and C. Latimer and L. Guzzo and F. Johnson and L. Gerwig and S. Fyffe and D. Loux and S. Frantz and D. Cline and S. Wylie and J. Iams and M. Wallace and A. Northen and J. Grant and C. Colquitt and D. Rouse and W. Andrews and G. Mallett and M. Ramos-Brinson and A. Roy and L. Stein and P. Campbell and C. Collins and N. Jackson and M. Dinsmoor and J. Senka and K. Paychek and A. Peaceman and J. Moss and A. Salazar and A. Acosta and G. Hankins and N. Hauff and L. Palmer and P. Lockhart and D. Driscoll and L. Wynn and C. Sudz and D. Dengate and C. Girard and S. Field and P. Breault and F. Smith and N. Annunziata and D. Allard and J. Silva and M. Gamage and J. Hunt and J. Tillinghast and N. Corcoran and M. Jimenez and F. Ortiz and P. Givens and B. Rech and C. Moran and M. Hutchinson and Z. Spears and C. Carreno and B. Heaps and G. Zamora and J. Seguin and M. Rincon and J. Snyder and C. Farrar and E. Lairson and C. Bonino and W. Smith and K. Beach and {Van Dyke}, S. and S. Butcher and E. Thom and Y. Zhao and P. McGee and V. Momirova and R. Palugod and B. Reamer and M. Larsen and T. Williams and T. Spangler and A. Lozitska and C. Spong and S. Tolivaisa and Vandorsten, {J. P.}",
year = "2016",
month = "7",
day = "1",
doi = "10.1016/j.ajog.2016.01.004",
language = "English (US)",
volume = "215",
pages = "103.e1--103.e14",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Preterm neonatal morbidity and mortality by gestational age

T2 - A contemporary cohort

AU - Manuck, Tracy A.

AU - Rice, Madeline Murguia

AU - Bailit, Jennifer L.

AU - Grobman, William A.

AU - Reddy, Uma M.

AU - Wapner, Ronald J.

AU - Thorp, John M.

AU - Caritis, Steve N.

AU - Prasad, Mona

AU - Tita, Alan T N

AU - Saade, George R.

AU - Sorokin, Yoram

AU - Rouse, Dwight J.

AU - Blackwell, Sean C.

AU - Tolosa, Jorge E.

AU - Varner, M.

AU - Hill, K.

AU - Sowles, A.

AU - Postma, J.

AU - Alexander, S.

AU - Andersen, G.

AU - Scott, V.

AU - Morby, V.

AU - Jolley, K.

AU - Miller, J.

AU - Berg, B.

AU - Talucci, M.

AU - Zylfijaj, M.

AU - Reid, Z.

AU - Leed, R.

AU - Benson, J.

AU - Forester, S.

AU - Kitto, C.

AU - Davis, S.

AU - Falk, M.

AU - Perez, C.

AU - Dorman, K.

AU - Mitchell, J.

AU - Kaluta, E.

AU - Clark, K.

AU - Spicer, K.

AU - Timlin, S.

AU - Wilson, K.

AU - Leveno, K.

AU - Moseley, L.

AU - Santillan, M.

AU - Price, J.

AU - Buentipo, K.

AU - Bludau, V.

AU - Thomas, T.

AU - Fay, L.

AU - Melton, C.

AU - Kingsbery, J.

AU - Benezue, R.

AU - Simhan, H.

AU - Bickus, M.

AU - Fischer, D.

AU - Kamon, T.

AU - Deangelis, D.

AU - Mercer, B.

AU - Milluzzi, C.

AU - Dalton, W.

AU - Dotson, T.

AU - McDonald, P.

AU - Brezine, C.

AU - McGrail, A.

AU - Latimer, C.

AU - Guzzo, L.

AU - Johnson, F.

AU - Gerwig, L.

AU - Fyffe, S.

AU - Loux, D.

AU - Frantz, S.

AU - Cline, D.

AU - Wylie, S.

AU - Iams, J.

AU - Wallace, M.

AU - Northen, A.

AU - Grant, J.

AU - Colquitt, C.

AU - Rouse, D.

AU - Andrews, W.

AU - Mallett, G.

AU - Ramos-Brinson, M.

AU - Roy, A.

AU - Stein, L.

AU - Campbell, P.

AU - Collins, C.

AU - Jackson, N.

AU - Dinsmoor, M.

AU - Senka, J.

AU - Paychek, K.

AU - Peaceman, A.

AU - Moss, J.

AU - Salazar, A.

AU - Acosta, A.

AU - Hankins, G.

AU - Hauff, N.

AU - Palmer, L.

AU - Lockhart, P.

AU - Driscoll, D.

AU - Wynn, L.

AU - Sudz, C.

AU - Dengate, D.

AU - Girard, C.

AU - Field, S.

AU - Breault, P.

AU - Smith, F.

AU - Annunziata, N.

AU - Allard, D.

AU - Silva, J.

AU - Gamage, M.

AU - Hunt, J.

AU - Tillinghast, J.

AU - Corcoran, N.

AU - Jimenez, M.

AU - Ortiz, F.

AU - Givens, P.

AU - Rech, B.

AU - Moran, C.

AU - Hutchinson, M.

AU - Spears, Z.

AU - Carreno, C.

AU - Heaps, B.

AU - Zamora, G.

AU - Seguin, J.

AU - Rincon, M.

AU - Snyder, J.

AU - Farrar, C.

AU - Lairson, E.

AU - Bonino, C.

AU - Smith, W.

AU - Beach, K.

AU - Van Dyke, S.

AU - Butcher, S.

AU - Thom, E.

AU - Zhao, Y.

AU - McGee, P.

AU - Momirova, V.

AU - Palugod, R.

AU - Reamer, B.

AU - Larsen, M.

AU - Williams, T.

AU - Spangler, T.

AU - Lozitska, A.

AU - Spong, C.

AU - Tolivaisa, S.

AU - Vandorsten, J. P.

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Background Although preterm birth <37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates. Objective We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages. Study Design This was a secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008 through 2011. All liveborn nonanomalous singleton preterm (23.0-36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade I/II, necrotizing enterocolitis stage I, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome for which criteria was met. Results In all, 8334 deliveries met inclusion criteria. There were 119 (1.4%) neonatal deaths. In all, 657 (7.9%) neonates had major morbidity, 3136 (37.6%) had minor morbidity, and 4422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25 weeks of gestation. As frequencies of death and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31 weeks of gestation. The frequency of all morbidities fell >32 weeks. After 25 weeks, neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26-32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median postmenstrual age at discharge nadired around 36 weeks' postmenstrual age for babies born at 31-35 weeks of gestation. Conclusion Our data show that there is a continuum of outcomes, with each additional week of gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.

AB - Background Although preterm birth <37 weeks' gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates. Objective We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages. Study Design This was a secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008 through 2011. All liveborn nonanomalous singleton preterm (23.0-36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade I/II, necrotizing enterocolitis stage I, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome for which criteria was met. Results In all, 8334 deliveries met inclusion criteria. There were 119 (1.4%) neonatal deaths. In all, 657 (7.9%) neonates had major morbidity, 3136 (37.6%) had minor morbidity, and 4422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25 weeks of gestation. As frequencies of death and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31 weeks of gestation. The frequency of all morbidities fell >32 weeks. After 25 weeks, neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26-32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median postmenstrual age at discharge nadired around 36 weeks' postmenstrual age for babies born at 31-35 weeks of gestation. Conclusion Our data show that there is a continuum of outcomes, with each additional week of gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.

KW - neonatal morbidity

KW - neonatal mortality

KW - prematurity

UR - http://www.scopus.com/inward/record.url?scp=84961218756&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84961218756&partnerID=8YFLogxK

U2 - 10.1016/j.ajog.2016.01.004

DO - 10.1016/j.ajog.2016.01.004

M3 - Article

VL - 215

SP - 103.e1-103.e14

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 1

ER -