Survival of preterm infants and their long-term outcomes: A literature review
DOI:
https://doi.org/10.37800/RM.3.2025.516Keywords:
preterm birth, prematurity, survival of premature infants, very low birth weight (VLBW), extremely low birth weight (ELBW), gestational age (GA), outcomes of premature birthAbstract
Relevance: The survival of extremely preterm infants with very low birth weight (VLBW) and extremely low birth weight (ELBW) remains a critical issue in modern neonatology. Despite advances in medical technologies, neonatal care, and perinatal management strategies, the rates of morbidity and mortality among these infants remain high. Of particular concern are the long-term outcomes, including respiratory, neurological, and neurosensory complications, which significantly affect survivors’ quality of life and developmental trajectories.
The study aimed to review scientific research findings and analyze current perspectives on the survival and long-term outcomes of extremely preterm infants.
Materials and Methods: A literature review was conducted using 50 studies published between 2016 and 2024, sourced from PubMed, Google Scholar, Scopus, Medline, Wiley, and the Cochrane Library, focusing on survival rates and long-term outcomes in preterm infants.
Results: Preterm birth before 32 weeks of gestation remains the primary cause of infant mortality. Survival rates have improved due to advances in neonatal technologies and care; however, they largely depend on gestational age. In 2019, the British Association of Perinatal Medicine (BAPM) updated its guidelines on resuscitation for infants born at 22 weeks of gestation, taking into account their mortality risk and the likelihood of severe adverse outcomes. Identified risk factors include male gender, intrauterine growth restriction (IUGR), congenital anomalies, multiple pregnancies, antenatal rupture of membranes with prolonged latency, and chorioamnionitis. Antenatal corticosteroid therapy and magnesium sulfate administration have improved neonatal outcomes. BAPM extended the viability threshold to include infants born at 22 weeks of gestation. Nevertheless, approximately one-third of these infants develop severe long-term disabilities. International statistics, including BAPM data, indicate that 30–35% of infants born at 22 weeks who receive active treatment survive hospital discharge, but around one-third of survivors experience significant long-term impairments.
Conclusion: Over the past two decades, the survival rates of extremely preterm infants have improved markedly due to the enhancement of medical technologies and perinatal care standards. However, there remains a high prevalence of long-term complications among survivors, particularly affecting neurodevelopment, respiratory, and cardiovascular systems.
References
1. Li YX, Hu YL, Huang X, Li J, Li X, Shi ZY, Yang R, Zhang XJ, Li Y, Chen Q. Survival outcomes among periviable infants: a systematic review and meta-analysis comparing different income countries and time periods. Front Public Health. 2024;12:1454433.
https://doi.org/10.3389/fpubh.2024.1454433
2. Chawanpaiboon S, Vogel JP, Moller AB, Lumbiganon P, Petzold M, Hogan D, Landoulsi S, Jampathong N, Kongwattanakul K, Laopaiboon M, Lewis C, Rattanakanokchai S, Teng DN, Thinkhamrop J, Watananirun K, Zhang J, Zhou W, Gülmezoglu AM. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019;7:e37-e46.
https://doi.org/10.1016/S2214-109X(18)30451-0
3. Torchina H, Morgan AS, Ancel PY. International comparisons of neurodevelopmental outcomes in infants born very preterm. Semin Fetal Neonatal Med. 2020;25(3).
https://www.sfnmjournal.com/article/S1744-165X(20)30034-2/fulltext
4. Boardman JP, Hall J, Thrippleton MJ, Reynolds RM, Bogaert D, Davidson DJ, Schwarze J, Drake AJ, Chandran S, Bastin ME, Fletcher-Watson S. Impact of preterm birth on brain development and long-term outcome: protocol for a cohort study in Scotland. BMJ Open. 2020;10:e035854.
https://doi.org/10.1136/bmjopen-2019-035854
5. Patel RM, Rysavy MA, Bell EF, Tyson JE. Survival of infants born at periviable gestational ages. Clin Perinatol. 2017;44:287–303.
https://doi.org/10.1016/j.clp.2017.01.009
6. Backes CH, Rivera BK, Pavlek L, Beer LJ, Ball MK, Zettler ET, Smith CV, Bridge JA, Bell EF, Frey HA. Proactive neonatal treatment at 22 weeks of gestation: a systematic review and meta-analysis. Am J Obstet Gynecol. 2021;224(2):158-174.
https://doi.org/10.1016/j.ajog.2020.07.051
7. Boghossian NS, Geraci M, Edwards EM, Ehret DEY, Saade GR, Horbar JD. Regional and racial-ethnic differences in perinatal interventions among periviable births. Obstet Gynecol. 2020;135:885-895.
https://doi.org/10.1097/AOG.0000000000003747
8. Fajolu I, Akintan PE, Ezenwa B, Chinyere EV. Survival of extremely preterm neonates in a resource-limited setting. Iran J Neonatol. 2019;10:32-37.
https://doi.org/10.22038/ijn.2019.38772.1611
9. Nimbalkar SM, Bansal SC. Periviable birth – the ethical conundrum. Indian Pediatr. 2019;56:13-17.
https://doi.org/10.1007/s13312-019-1459-9
10. Ahmed M, Billoo AG, Iqbal K, Memon A. Clinical efficacy of lactase enzyme supplement in infant colic: a randomised controlled trial. J Pak Med Assoc. 2018;68(12):1744-1747.
https://pubmed.ncbi.nlm.nih.gov/30504935/
11. Chen R, Sjölander A, Johansson S, Lu D, Razaz N, Tedroff K, Villamor E, Cnattingius S. Impact of gestational age on risk of cerebral palsy: unravelling the role of neonatal morbidity. Int J Epidemiol. 2021;50(6):1852–1863.
https://doi.org/10.1093/ije/dyab131
12. Fitzallen GC, Taylor HG, Bora S. What do we know about the preterm behavioral phenotype? Front Psychiatry. 2020;11:154.
https://doi.org/10.3389/fpsyt.2020.00154
13. British Association of Perinatal Medicine. Perinatal Management of Extreme Preterm Birth Before 27 weeks of Gestation (2019) | British Association of Perinatal Medicine [Internet]. Bapm.org. 2019. Available from:
14. Kawamura A, Makino A, McLeod S. Comprehensive care of the ambulatory child with cerebral palsy (GMFCS I and II): a Canadian perspective. Paediatr Child Health. 2020;25(6):397–398.
15. QUALITY OF CARE [Internet]. [cited 2025 May 18]. Available from: https://canadianneonatalfollowup.ca/wp-content/uploads/2023/05/Annual-Report-2020.pdf
16. Adilbekova IM, Bozhbanbaeva NS. Intraventricular hemorrhages in premature infants: risk factors, epidemiology, consequences for the nervous system development: a literature review. Reprod Med. 2024;2:119–127.
https://doi.org/10.37800/RM.2.2024.119-127
17. Lin CY, Hsu CH, Chang JH, Taiwan Premature Infant Follow-up Network. Neurodevelopmental outcomes at 2 and 5 years of age in very-low-birth-weight preterm infants born between 2002 and 2009: a prospective cohort study in Taiwan. Pediatr Neonatol. 2020;61(1):36-44.
https://doi.org/10.1016/j.pedneo.2019.05.006
18. Frezza S, Tiberi E, Corsello M, Priolo F, Cota F, Catenazzi P, Conti G, Costa S, Vento G. Hearing loss and risk factors in very low birth weight infants. J Clin Med. 2023;12:7583.
https://doi.org/10.3390/jcm12247583
19. Yu CW, Popovic MM, Dhoot AS, Arjmand P, Muni RH, Tehrani NN, Mireskandari K, Kertes PJ. Demographic risk factors of retinopathy of prematurity: a systematic review of population-based studies. Neonatology. 2022;119(2):151-163.
https://doi.org/10.1159/000519635
20. Hartnett ME. Pathophysiology of retinopathy of prematurity. Annu Rev Vis Sci. 2023;9:39-70.
https://doi.org/10.1146/annurev-vision-093022-021420
21. Haugen OH, Nepstad L, Standal OA, Elgen I, Markestad T. Visual function in 6 to 7-year-old children born extremely preterm: a population-based study. Acta Ophthalmol. 2012;90(5):422–427.
https://doi.org/10.1111/j.1755-3768.2010.02020.x
22. Petursdottir D, Holmstrom G, Larsson E. Strabismus, stereoacuity, accommodation and convergence in young adults born premature and screened for retinopathy of prematurity. Acta Ophthalmol. 2022;100(3):e791-e797.
https://doi.org/10.1111/aos.14987
23. Jain S, Sim PY, Beckmann J, Ni Y, Uddin N, Unwin B, Marlow N. Functional ophthalmic factors associated with extreme prematurity in young adults. JAMA Netw Open. 2022;5(1):e2145702.
https://doi.org/10.1001/jamanetworkopen.2021.45702
24. Caskey S, Gough A, Rowan S, Gillespie S, Clarke J, Riley M, Megarry J, Nicholls P, Patterson C, Halliday HL, Shields MD, McGarvey L. Structural and functional lung impairment in adult survivors of bronchopulmonary dysplasia. Ann Am Thorac Soc. 2016;13(8):1262-1270.
https://doi.org/10.1513/annalsats.201509-578oc
25. Walicka-Serzysko K, Postek M, Borawska-Kowalczyk U, Szamotulska K, Kwaśniewicz P, Polak K, Mierzejewska E, Sands D, Rutkowska M. Long-term pulmonary outcomes of young adults born prematurely: a Polish prospective cohort study PREMATURITAS 20. BMC Pulm Med. 2024;24:126.
https://doi.org/10.1186/s12890-024-02939-5
26. Rutkowska M, Hożejowski R, Helwich E, Borszewska-Kornacka MK, Gadzinowski J. Severe bronchopulmonary dysplasia – incidence and predictive factors in a prospective, multicenter study in very preterm infants with respiratory distress syndrome. J Matern Fetal Neonatal Med. 2019;32(12):1958-1964.
https://doi.org/10.1080/14767058.2017.1422711
27. Owen LS, Manley BJ, Davis PG, Doyle LW. The evolution of modern respiratory care for preterm infants. Lancet. 2017;389(10079):1649-1659.
https://doi.org/10.1016/S0140-6736(17)31364-6
28. Reynolds P, Bustani P, Darby C, Fernandez Alvarez JR, Fox G, Jones S, Robertson SJ, Vasu V, Roehr CC. Less-invasive surfactant administration for neonatal respiratory distress syndrome: a consensus guideline. Neonatology. 2021;118(5):586-592.
https://doi.org/10.1159/000518396
29. Luu TM, Rehman Mian MO, Nuyt AM. Long-term impact of preterm birth: neurodevelopmental and physical health outcomes. Clin Perinatol. 2017;44(2):305-314.
https://doi.org/10.1016/j.clp.2017.01.003
30. Raju TNK, Pemberton VL, Saigal S, Blaisdell CJ, Moxey-Mims M, Buist S. Long-term healthcare outcomes of preterm birth: an executive summary of a conference sponsored by the National Institutes of Health. J Pediatr. 2017;181:309-318.e1.
https://doi.org/10.1016/j.jpeds.2016.10.015
31. Goss KN, Haraldsdottir K, Beshish AG, Barton GP, Watson AM, Palta M, Chesler NC, Francois CJ, Wieben O, Eldridge MW. Association between preterm birth and arrested cardiac growth in adolescents and young adults. JAMA Cardiol. 2020;5(8):910-919.
https://doi.org/10.1001/jamacardio.2020.1511
32. Morniroli D, Tiraferri V, Maiocco G, De Rose DU, Cresi F, Coscia A, Mosca F, Giannì ML. Beyond survival: the lasting effects of premature birth. Front Pediatr. 2023;11:1213243.
https://doi.org/10.3389/fped.2023.1213243
33. Hovi P, Vohr B, Ment LR, Doyle LW, McGarvey L, Morrison KM, Evensen KA, van der Pal S, Grunau RE; APIC Adults Born Preterm International Collaboration; Brubakk AM, Andersson S, Saigal S, Kajantie E. Blood pressure in young adults born at very low birth weight: Adults Born Preterm International Collaboration. Hypertension. 2016;68(4):880-887.
https://doi.org/10.1161/HYPERTENSIONAHA.116.08167
34. South AM, Nixon PA, Chappell MC, Diz DI, Russell GB, Jensen ET, Shaltout HA, OʼShea TM, Washburn LK. Association between preterm birth and the renin–angiotensin system in adolescence: influence of sex and obesity. J Hypertens. 2018;36(10):2092-2101.
https://doi.org/10.1097/HJH.0000000000001801
35. Crump C, Howell EA, Stroustrup A, McLaughlin MA, Sundquist J, Sundquist K. Association of preterm birth with risk of ischemic heart disease in adulthood. JAMA Pediatr. 2019;173(8):736-743.
https://pubmed.ncbi.nlm.nih.gov/31157896/
36. Pravia CI, Benny M. Long-term consequences of prematurity. Cleveland Clin J Med. 2020;87(12):759-767.
https://doi.org/10.3949/ccjm.87a.19108
37. Grillo MA, Mariani G, Ferraris JR. Prematurity and low birth weight in neonates as a risk factor for obesity, hypertension, and chronic kidney disease in pediatric and adult age. Front Med (Lausanne). 2022;8:769734.
https://doi.org/10.3389/fmed.2021.769734
38. Didion SP. A novel genetic model to explore the Brenner hypothesis: Linking nephron endowment and number with hypertension. Med Hypotheses. 2017;106:6-9.
https://doi.org/10.1016/j.mehy.2017.06.020
39. Cheong JLY, Burnett AC, Treyvaud K, Spittle AJ. Early environment and long-term outcomes of preterm infants. J Neural Transm. 2020;127:1–8.
https://doi.org/10.1007/s00702-019-02121-w
40. CDC. Assessing Growth | Using the WHO Growth Charts | Growth Birth to 2 Years | WHO | Growth Chart Training | Nutrition | DNPAO | CDC [Internet]. www.cdc.gov. 2019. Available from: https://www.cdc.gov/nccdphp/dnpao/growthcharts/who/using/assessing_growth.htm
41. Jańczewska I, Wierzba J, Jańczewska A, Szczurek-Gierczak M, Domżalska-Popadiuk I. Prematurity and low birth weight and their impact on childhood growth patterns and the risk of long-term cardiovascular sequelae. Children. 2023;10(10):1599.
https://doi.org/10.3390/children10101599
42. Salas A, Griffin IJ. Growth and feeding issues in the neonatal intensive care unit. UpToDate.
https://www.uptodate.com/contents/growth-and-feeding-issues-in-the-neonatal-intensive-care-unit-graduate. Accessed May 2, 2025.
43. Lenfestey MW, Neu J. Gastrointestinal development: implications for management of preterm and term infants. Gastroenterol Clin North Am. 2018;47(4):773-791.
https://doi.org/10.1016/j.gtc.2018.07.005
44. Fitzallen GC, Taylor HG, Bora S. What do we know about the preterm behavioral phenotype? Front Psychiatry. 2020;11:154.
https://doi.org/10.3389/fpsyt.2020.00154
45. Shaw RJ, Givrad S, Poe C, Loi EC, Hoge MK, Scala M. Neurodevelopmental, mental health, and parenting issues in preterm infants. Children (Basel). 2023;10(9):1565.
https://doi.org/10.3390/children10091565
46. Agrawal S, Rao SC, Bulsara MK, Patole SK. Prevalence of autism spectrum disorder in preterm infants: a meta-analysis. Pediatrics. 2018;142(3):e20180134.
https://pubmed.ncbi.nlm.nih.gov/30076190/
47. Zwaigenbaum L, Brian JA, Ip A; Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force. Early detection for autism spectrum disorder in young children. Paediatr Child Health. 2019;24(7):424-432.
https://pubmed.ncbi.nlm.nih.gov/31660041/
48. Choi JY, Rha DW, Park ES. The effects of the severity of periventricular leukomalacia on the neuropsychological outcomes of preterm children. J Child Neurol. 2016;31(5):603-612.
https://doi.org/10.1177/0883073815604229
49. Rogers CE, Sylvester CM, Mintz C, Kenley JK, Shimony JS, Barch DM, Smyser CD. Neonatal amygdala functional connectivity at rest in healthy and preterm infants and early internalizing symptoms. J Am Acad Child Adolesc Psychiatry. 2017;56(2):157-166.
https://doi.org/10.1016/j.jaac.2016.11.005
50. Litt JS, Halfon N, Msall ME, Russ SA, Hintz SR. Ensuring optimal outcomes for preterm infants after NICU discharge: a life course health development approach to high-risk infant follow-up. Children. 2024;11(2):146.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Н.С. Божбанбаева , И.Е. Сулейменова , С. Саиранкызы, А.А. Айдарова , М.Т. Нармұхамбет
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The articles published in this Journal are licensed under the CC BY-NC-ND 4.0 (Creative Commons Attribution – Non-Commercial – No Derivatives 4.0 International) license, which provides for their non-commercial use only. Under this license, users have the right to copy and distribute the material in copyright but are not permitted to modify or use it for commercial purposes. Full details on the licensing are available at https://creativecommons.org/licenses/by-nc-nd/4.0/.
