Outlook for premature babies improving

16 February 2017
Premature baby

More babies born extremely prematurely are surviving without neurological problems, according to a new study.

The study by Duke Health and published in the New England Journal of Medicine looked at more than 4,200 infants born between 22 and 24 weeks.

Compared to extremely preterm babies born a decade earlier, the study found a larger percentage are developing into toddlers without signs of moderate or severe cognitive and motor delay.

The authors suggest that changes to prenatal care, including greater use of steroids in mothers at risk for preterm birth, may have contributed to increased survival and fewer signs of developmental delay.

Neonatologist and assistant professor of pediatrics at Duke, Dr Noelle Younge, says the findings are encouraging.

“We see evidence of improvement over time. But we do need to keep an eye on the overall numbers, as a large percentage of infants born at this stage still do not survive. Those who survive without significant impairment at about age two are still at risk for numerous other challenges to their overall health.”

The research found that about 30% of infants born at the beginning of the study (between 2000 and 2003), survived. However, that proportion increased to 36% for babies born toward the end of the study (from 2008 to 2011).

The best outcomes were seen in children at 23 and 24 weeks. Overall survival for babies born at 22 weeks remained the same throughout the study, at just 4%.

Over the 12-year study period, the proportion of infants who survived but were found to have cognitive and motor impairment at 18 to 22 months stayed about the same (about 14 to 16 %). But the proportion of babies who survived without evidence of moderate or severe neurological impairment improved from 16 percent to 20%.

“There has been concern was that improved survival might have been accompanied by a greater number of infants who went on to have impairments in the long term, such as cerebral palsy, developmental delay, hearing and vision loss.

“However, we actually are seeing a slight improvement. Because children continue to develop over years, it’s important to continue to track this data so families and providers can make the best decisions in caring for these infants.”

Improvements in survival and neurodevelopment may be the result of a number of factors, including declining rates of infection in the infants as well as the increased use of steroids in expectant mothers that can help mature and strengthen the fetus’s lungs prior to birth.

At the beginning of the study, 58% of the expectant mothers had received steroids to boost fetal development. That figure increased to 64% by the end of the study.

In addition, the Duke researchers continue to study environmental and genetic factors, as well as the babies’ gut bacteria and metabolomics.

You can read the full study here.