RESEARCH TRIANGLE PARK, NC – Some premature babies may survive as early as 22 weeks if given active treatment according to a study by RTI International and investigators from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.
The study, published in The New England Journal of Medicine, found hospitals that initiated active treatment more often to extremely premature babies had higher rates of survival than hospitals where active treatment was less frequent.
"For infants born so close to the limits of viability, the decision to initiate or forgo a possibly lifesaving treatment is difficult for parents and clinicians," said Abhik Das, Ph.D., RTI's principal investigator on the project and co-author of the study. "This is especially so because the causes of survival in these babies are so complex and multifactorial that no simple formula can be used to help guide individual treatment decisions."
RTI has served as the data-coordinating center for the National Institute of Child Health and Human Development Neonatal Research Network since 1998 by helping clinical investigators conceive the study and conducting all statistical analyses and data management.
During the study, more than 4,000 premature infants received active treatment at 24 hospitals. The treatment was administered to infants born at 22 to 26 weeks of gestation.
Among infants who received active treatment, 65 percent survived and more than 56 percent survived without severe neurodevelopmental impairment. All infants who did not receive active treatment died within 24 hours after birth.
However, among infants born between 22 to 23 weeks of gestation, overall rates of active treatment were significantly higher among infants born in the last few days of the gestational week than those born earlier in the same week, as hospitals tend to round up when deciding whether to initiate treatment.
Differences among hospitals on when to start active treatment for extremely preterm infants seem to explain the varied survival rates among such infants across different hospitals, according to the study.
Rates of active treatment vary widely among infants born between 22 and 24 weeks; yet, most hospitals provided active treatment to all infants born at 25 or 26 weeks.
"Hospitals often use their own outcome data based on local approaches when counseling families about the benefits and burdens of initiating active treatment," Das said. "However, looking only at one's own hospital data could lead to a self-fulfilling prophecy, and this study shows that some premature babies can survive and benefit from active treatment at 22 weeks."
Das led the data coordinating center for the project with Lei Li, Ph.D., a senior research statistician at RTI and co-author of the study.