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ELBW Outcomes to Discharge
The EPICure Study:
Outcomes to discharge from Hospital for Infants Born at the
Threshold of Viability. Costeloe K, Hennessy E, Gibson AT, et al.
Pediatrics 2000; 106 : 659-71.
This prospective observational study reports the survival and
complications up until hospital discharge for all infants born at
20-25 weeks gestation in the United Kingdom and Ireland between
March 1, 1995 and December 31, 1995. A total of 4004 birth were
recorded and 811 infants were admitted for intensive care.
Overall survival was 39%. Male sex, no reported chorioamnionitis,
no antenatal steroids, persistent bradycardia at 5 minutes,
hypothermia, and high CRIB score were all independently
associated with death. Of the survivors, 17% had parenchymal
cysts and/or hydrocephalus, 14% received treatment for ROP, and
51% needed supplemental oxygen at the expected date of delivery.
Failure to administer antenatal steroids and postnatal transfer
for intensive care within 24 hours of birth were predictive of a
major scan abnormality; lower gestation was predictive of severe
ROP, while being born to a black mother was protective. Being of
lower gestation, male sex, tocolysis low maternal age, neonatal
hypothermia, a high CRIB score, and surfactant therapy were all
predictive of oxygen dependency.
Comment. This is a companion study by the EPICure study group to the NEJM study reviewed recently in FSN Journal club (reference #1-025). Due to the observational nature of this study, it would be improper to infer cause and effect relationships between the associations identified. However, I see two areas where these data should suggest possible changes in our routine management of these micro-premies pending more definitive studies. The first of these is the lack of effectiveness of surfactant therapy. In this study population, surfactant use was not associated with increased survival, and was associated with a higher frequency of chronic oxygen dependency. This finding was true for both artificial and animal-based surfactants. Since there is no significant pulmonary alveolarization at < 26 weeks gestation, this lack of surfactant benefit might be expected. The second area of possible change to consider is whether to delay transfer of these infants for level III NICU care. Babies transferred within 24 hours of birth in this study had a higher incidence of IVH or PVL.
The strength of this study is its large sample size. The study population included all babies 20-25 weeks gestation born in the United Kingdom and Ireland during the 10 month study period. Wouldn’t it be great if we could collect and report similar data from all Florida NICU’s through FSN’s NICU Outcomes Data Collection Project!
Andrew B. Kairalla MD