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Abstract
Objective To examine whether changes in survival without moderate or severe neurodevelopmental impairment (NDI) at 18–26 months’ corrected age from 1999 to 2018 differed between male and female infants.
Design This retrospective cohort study used data from the NICHD Neonatal Research Network hospitals. Robust Poisson regression models were used to estimate adjusted relative risks (aRRs) and 95% CIs for survival without moderate or severe NDI between males and females. Interactions between sex and time were assessed to evaluate temporal differences in the outcome by sex. Variables adjusted for included centre, maternal age, ethnicity/race, gestational age and small for gestational age.
Patients Inborn infants with gestational age of 22–26 weeks at NICHD Neonatal Research Network hospitals from 1999 to 2018.
Main outcome measure Change over time in survival without moderate or severe NDI at 18–26 months’ corrected age between male and female infants.
Results Of 26 307 infants, 13 045 (49.6%) were male. Survival without moderate or severe NDI declined for both sexes over time, from 32.9% to 30.6% for males and from 47.4% to 40.0% for females, between 1999–2003 and 2014–2018. Males were less likely than females to survive without moderate or severe NDI (aRR=0.80; 95% CI 0.78 to 0.83). Changes in survival without moderate or severe NDI did not differ between males and females.
Conclusion There were no differential changes in survival without moderate or severe NDI between male and female infants.
- Epidemiology
- Infant Development
- Neonatology
Data availability statement
Data may be obtained from a third party and are not publicly available. Data reported in this paper may be requested through a data use agreement. Further details are available at https://neonatal.rti.org/index.cfm?fuseaction=DataRequest.Home.
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Data availability statement
Data may be obtained from a third party and are not publicly available. Data reported in this paper may be requested through a data use agreement. Further details are available at https://neonatal.rti.org/index.cfm?fuseaction=DataRequest.Home.
Footnotes
X @SusanHintzMD
Correction notice This paper has been corrected since it was first published. The authors' affiliations have been updated.
Collaborators NRN Steering Committee Chairs: Alan H Jobe, MD, PhD, University of Cincinnati (2003–2006); Michael S Caplan, MD, University of Chicago, Pritzker School of Medicine (2006–2011); Richard A Polin, MD, Division of Neonatology, College of Physicians and Surgeons, Columbia University (2011 to present). Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island (UG1 HD27904)—William Oh, MD; Martin Keszler, MD; Abbot R Laptook, MD; Betty R Vohr, MD; Angelita M Hensman, PhD, RNC-NIC; Robert T Burke, MD, MPH; Bonnie E Stephens, MD; Yvette Yatchmink, MD; Barbara Alksninis, RNC, PNP; Kristin Basso, RN, MaT; Elisa Vieira, RN, BSN; Lenore Keszler, MD; Andrea Knoll; Teresa M Leach, MEd, CAES; Martha R Leonard, BA, BS; Lucy Noel; Lucille St Pierre, BS; Rachel A Vogt, MD; Victoria E Watson, MS, CAS. Case Western Reserve University, Rainbow Babies & Children's Hospital (UG1 HD21364, M01 RR80)—Anna Maria Hibbs, MD; Avroy A Fanaroff, MD; Deanne E Wilson-Costello, MD; Nancy S Newman, RN; Bonnie S Siner, RN; Angelia Williams; Elizabeth Roth, PhD. Children's Mercy Hospital, University of Missouri Kansas City School of Medicine (UG1 HD68284)—William Truog, MD; Howard Kilbride, MD; Prabhu Parimi, MD; Cheri Gauldin, RN, BSN, CCRC; Allie Scott, RN, CCRC; Kathy Johnson, RN, CCRC; Lisa Gaetano, RN, MSN. Cincinnati Children's Hospital Medical Center, University Hospital, and Good Samaritan Hospital (UG1 HD27853, M01 RR8084)—Stephanie L Merhar, MD MS; Brenda B Poindexter, MD, MS; Kurt Schibler, MD; David Russell, JD; Edward F Donovan, MD; Kate Bridges, MD; Jean J Steichen, MD; Kimberly Yolton, PhD; Barbara Alexander, RN; Estelle E Fischer, MHSA, MBA; Cathy Grisby, BSN, CCRC; Marcia Worley Mersmann, RN; Holly L Mincey, RN, BSN; Jody Hessling, RN; Teresa L Gratton, PA; Lenora D Jackson, CRC; Kristin Kirker, CRC; Greg Muthig, BS; Sara Stacey, CRC; Devan Hayes, CRC; Julia Thompson, RN, BSN; Traci Beiersdorfer, RN, BSN. Duke University School of Medicine, University Hospital, Duke Regional Hospital, and the University of North Carolina (UG1 HD40492, M01 RR30)—Ronald N Goldberg, MD; C Michael Cotten, MD, MHS; Ricki F Goldstein, MD; Kathy J Auten, MSHS; Joanne Finkle, RN, JD; Kimberley A Fisher, PhD, FNP-BC, IBCLC; Katherine A Foy, RN; Sandra Grimes, RN, BSN; Kathryn E Gustafson, PhD; Melody B Lohmeyer, RN, MSN; Matthew M Laughon, MD, MPH; Carl L Bose, MD; Janice Bernhardt, MS, RN; Gennie Bose, RN; Cynthia L Clark, RN. Emory University, Children’s Healthcare of Atlanta, Grady Memorial Hospital, and Emory University Hospital Midtown (UG1 HD27851, M01 RR39)—Ravi M Patel, MD, MSc; David P Carlton, MD; Ira Adams-Chapman, MD (deceased); Ellen C Hale, RN, BS, CCRC; Yvonne C Loggins, RN, BSN; Diane I Bottcher, RN, MSN; Maureen Mulligan LaRossa, RN; Sheena L Carter, PhD; Liz Sewell, MD; Amy Sanders, PhD; Gloria Smikle, RN, PNP; Colleen Mackie, RRT; Judith Laursen, RN. Eunice Kennedy Shriver National Institute of Child Health and Human Development—Andrew A Bremer, MD, MPH; Rosemary D Higgins, MD; Linda L Wright, MD; Elizabeth M McClure, MEd; Stephanie Wilson Archer, MA. Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children, and Wishard Health Services (UG1 HD27856, M01 RR750)—Gregory M Sokol, MD; Brenda B Poindexter, MD, MS; James A Lemons, MD; Anna M Dusick, MD (deceased); Lu-Ann Papile, MD; Heidi Harmon, MD, MS; Carolyn Lytle, MD, MPH; Lon G Bohnke, MS; Greg Eaken, PhD; Dianne E Herron, RN, CCRC; Abbey Hines, PsyD; Lucy C Miller, RN, BSN, CCRC; Heike M Minnich, PsyD, HSPP; Leslie Richard, RN; Leslie Dawn Wilson, BSN, CCRC; Donna Watkins, MSN, NNP-BC; Susan Gunn, NNP-BC, CCRC; Jeff Joyce, CCRC (deceased). McGovern Medical School at The University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, and Lyndon Baines Johnson General Hospital/Harris County Hospital District (UG1 HD21373)—Amir M Khan, MD; Kathleen A Kennedy, MD, MPH; Patrick M Jones, MD; Patricia W Evans, MD; Esther G Akpa, RN, BSN; Nora I Alaniz, BS; Elizabeth Allain, PhD; Julie Arldt-McAlister, R; Fatima Boricha, MD; Pamela Brandt, MD, MPH, BSN; Katrina Burson, RN, BSN; Magda Cedillo Guajardo, RB, BSN, FAACM; Allison Dempsey, PhD; Susan E Dieterich, PhD; Beverly Foley Harris, RN, BSN; Claudia I Franco, RNC, MSN; Carmen Garcia, RN, CCRP; Charles Green, PhD; Donna Hall, RN; Margarita Jiminez, MD, MPH; Janice John, CPNP; Anna E Lis, RN, BSN; Terri Major-Kincade, MD, MPH; Karen Martin, RN; Sara C Martin, RN, BSN; Carrie M Mason, MA, LPA; Georgia E McDavid, RN; Shannon L McKee, EdS; Brenda H Morris, MD; Patricia Ann Orekoya, RN, BSN; Debasree Sana Boral, IMG; Patti L Pierce Tate, RCP; M Layne Poundstone Lillie, RN, BSN; Stacey Reddoch, BA; Tina Reddy, MD; Shawna Rodgers, RN; Saba Khan Siddiki, MD; Maegan C Simmons, RN; Daniel Sperry, RN; Emily Stephens, BSN, RNC-NIC; Laura L Whitely, MD; Sharon L Wright, MT. Nationwide Children’s Hospital and the Ohio State University Medical Center (UG1 HD68278)—Pablo J Sánchez, MD; Leif D Nelin, MD; Sudarshan R Jadcherla, MD; Patricia Luzader, RN; Christine A Fortney, PhD, RN; Gail E Besner; Nehal A Parikh, MD. RTI International (U01 HD36790)—W Kenneth Poole, PhD (deceased); Dennis Wallace, PhD; Jamie E Newman, PhD, MPH; Jeanette O’Donnell Auman, BS; Margaret M Crawford, BS, CCRP; Betty K Hastings; Elizabeth M McClure, PhD; Carolyn M Petrie Huitema, MS, CCRP; Kristin M Zaterka-Baxter, RN, BSN, CCRP. Stanford University, California Pacific Medical Center, Dominican Hospital, El Camino Hospital, and Lucile Packard Children's Hospital (UG1 HD27880, M01 RR70)—Krisa P Van Meurs, MD; Valerie Y Chock, MD; David K Stevenson, MD; M Bethany Ball, BSc, CCRC; Marian M Adams, MD; Charles E Ahlfors, MD; Joan M Baran, PhD; Barbara Bentley, PsychD, MSEd; Lori E Bond, PhD; Ginger K Brudos, PhD; Alexis S Davis, MD, MS, Epi; Maria Elena DeAnda, PhD; Anne M DeBattista, RN, PNP; Barry E Fleisher, MD; Lynne C Huffman, MD; Jean G Kohn, MD, MPH; Casey Krueger, PhD; Julie C Lee-Ancajas, PhD; Andrew W Palmquist, RN, BSN; Melinda S Proud, RCP; Renee P Pyle, PhD; Dharshi Sivakumar, MD; Robert D Stebbins, MD; Nicholas H St John, PhD; Halie E Weiss, MD. Tufts Medical Center, Floating Hospital for Children (U10 HD53119, M01 RR54)—Ivan D Frantz III, MD; Elisabeth C McGowan, MD; Brenda L MacKinnon, RNC; Ellen Nylen, RN, BSN; Anne Furey, MPH; Ana Brussa, MS, OTR/L; Cecelia Sibley, PT, MHA. University of Alabama at Birmingham Health System and Children’s Hospital of Alabama (UG1 HD34216, M01 RR32)—Myriam Peralta-Carcelen, MD, MPH; Kathleen G Nelson, MD; Kirstin J Bailey, PhD; Fred J Biasini, PhD (deceased); Stephanie A Chopko, PhD; Monica V Collins, RN, BSN, MaEd; Shirley S Cosby, RN, BSN; Mary Beth Moses, PT, MS, PCS; Vivien A Phillips, RN, BSN; Julie Preskitt, MSOT, MPH; Richard V Rector, PhD; Sally Whitley, MA, OTR-L, FAOTA. University of California–Los Angeles, Mattel Children's Hospital, Santa Monica Hospital, Los Robles Hospital and Medical Center, and Olive View Medical Center (UG1 HD68270)—Uday Devaskar, MD; Meena Garg, MD; Isabell B Purdy, PhD, CPNP; Teresa Chanlaw, MPH; Rachel Geller, RN, BSN. University of California–San Diego Medical Center and Sharp Mary Birch Hospital for Women and Newborns (U10 HD40461)—Neil N Finer, MD; Maynard R Rasmussen, MD; Yvonne E Vaucher, MD, MPH; Paul R Wozniak, MD; Kathy Arnell, RNC; Renee Bridge, RN; Clarence Demetrio, RN; Martha G Fuller, RN, MSN; Wade Rich, BSHS, RRT. University of Iowa, Sanford Health, and Mercy Medical Center (UG1 HD53109, M01 RR59)—Tarah T Colaizy, MD, MPH; John A Widness, MD; Heidi M Harmon, MD, MS; Jane E Brumbaugh, MD; Michael J Acarregui, MD, MBA; Karen J Johnson, RN, BSN; Diane L Eastman, RN, CPNP, MA; Jacky R Walker, RN; Claire A Goecke, RN; Mendi L Schmelzel, RN, MSN; Michelle L Baack, MD; Laurie A Hogden, MD; Megan M Henning, RN; Chelsey Elenkiwich, RN, BSN; Megan Broadbent, RN, BSN; Sarah Van Muyden, RN, BSN; Dan L Ellsbury, MD; Donia B Bass, MS, ARNP, NNP-BC; Tracy L Tud, RN. University of Miami, Holtz Children's Hospital (U10 HD21397, M01 RR16587)—Shahnaz Duara, MD; Charles R Bauer, MD (deceased); Ruth Everett-Thomas, RN, MSN; Amy Mur Worth, RN, MS; Mary Allison, RN; Alexis N Diaz, BA; Elaine E Mathews, RN; Kasey Hamlin-Smith, PhD; Lissa Jean-Gilles, BA; Maria Calejo, MS; Silvia M Frade Eguaras, BA; Silvia Fajardo-Hiriart, MD; Yamiley C Gideon, BA; Michelle Harwood Berkovits, PhD; Alexandra Stoerger, BA; Andrea Garcia, MA; Helena Pierre, BA; Georgette Roder, BSW; Arielle Riguad, MD. University of New Mexico Health Sciences Center (U10 HD27881, UG1 HD53089, M01 RR997)—Kristi L Watterberg, MD; Janell Fuller, MD; Robin K Ohls, MD; Lu-Ann Papile, MD; Conra Backstrom Lacy, RN; Carol Hartenberger, BSN, MPH; Sandra Brown, RN, BSN; Jean R Lowe, PhD; Rebecca Montman, BSN; Sandra Beauman, MSN; Mary Hanson, BSN; Elizabeth Kuan, BSN. University of Pennsylvania, Hospital of the University of Pennsylvania, Pennsylvania Hospital, Children's Hospital of Philadelphia, and Virtua Voorhees Hospital (UG1 HD68244)—Sara B DeMauro, MD, MSCE; Eric C Eichenwald, MD; Barbara Schmidt, MD, MSc; Haresh Kirpalani, MB, MSc; Aasma S Chaudhary, BS, RRT; Soraya Abbasi, MD; Dara M Cucinotta, RN; Judy C Bernbaum, MD; Christine Catts, CRNP; Marsha Gerdes, PhD; Sarvin Ghavam, MD; Hallam Hurt, MD; Toni Mancini, RN, BSN, CCRC; Jonathan Snyder, RN BSN; Kristina Ziolkowski, CMA (AAMA), CCRP. University of Rochester Medical Center, Golisano Children's Hospital, and the University of Buffalo Women's and Children's Hospital of Buffalo (UG1 HD68263, U10 HD40521, M01 RR44, UL1 TR42)—Carl T D’Angio, MD; Dale L Phelps, MD; Ronnie Guillet, MD, PhD; Satyan Lakshminrusimha, MD; Gary J Myers, MD; Erica Burnell, RN; Stephanie Guilford, BS; Cassandra A Horihan, MS; Diane Hust, MS, RN, CS; Rosemary L Jensen; Julie Babish Johnson, MSW; Emily Kushner, MA; Deanna Maffett, RN; Joan Merzbach, LMSW; Linda J Reubens, RN, CCRC; Ann Marie Reynolds, MD; Mary Rowan, RN; Holly I M Wadkins; Ashley Williams, MS, Ed; Kelly Yost, PhD; Lauren Zwetsch, RN, MS, PNP; Alison Kent, MD; Diane Prinzing, AAS; Ann Marie Scorsone, MS, CCRC; Julianne Hunn, BS; Melissa Bowman, RN; Constance Orme; Kyle Binion, BS; Premini Sabaratnam, MPH; Rachel Jones; Elizabeth Boylin, BA; Kim McKee, MPH; Michael Sacilowski, MAT, CCRC; Daisy Rochez, BS, MHA; Emily Li, BA; Jennifer Kachelmeyer, BS; Kelly Coleman, PsyD; Michele Hartley-McAndrew, MD; Osman Farooq, MD; William Zorn, MD. University of Tennessee Health Science Center (U10 HD21415)—Sheldon B Korones, MD (deceased); Henrietta S Bada, MD; Tina Hudson, RN, BSN; Marilyn Williams, LCSW; Kimberly Yolton, PhD. University of Texas Southwestern Medical Center, Parkland Health & Hospital System and Children's Medical Center Dallas (UG1 HD40689, M01 RR633)—Myra H Wyckoff, MD; Luc P Brion, MD; Pablo J Sánchez, MD; Abbot R Laptook, MD; Charles R Rosenfeld, MD; Walid A Salhab, MD; R Sue Broyles, MD; Roy J Heyne, MD; Merle Ipson, MD; Sally S Adams, MS, RN, CPNP; P Jeannette Burchfield, RN, BSN; Lijun Chen, PhD, RN; Maria De Leon, RN; Cristin Dooley, PhD, LSSP; Francis Eubanks, RN; Alicia Guzman; Gaynelle Hensley, RN; Elizabeth T Heyne, MS, MA, PA-C, PsyD; Jackie F Hickman, RN; Melissa H Leps, RN; Linda A Madden, BSN, RN, CPNP; Susie Madison, RN; E Rebecca McDougald, MSN, APRN, CPNP-PC/AC; Nancy A Miller, RN; Janet S Morgan, RN; Lizette E Lee, RN; Lara Pavageau, MD; Anna Puentez, MSN, RN, CPNP-PC; Pollieanna Sepulveda, RN; Kristine Tolentino-Plata, MS; Cathy Twell Boatman, MS, CIMI; Diana M Vasil, RNC-NIC; Jillian Waterbury, DNP, RN, CPNP-PC. University of Utah Medical Center, Intermountain Medical Center, LDS Hospital, McKay-Dee Hospital, Utah Valley Hospital, and Primary Children's Medical Center (UG1 HD87226, U10 HD53124, UL1 TR105, M01 RR64)—Bradley A Yoder, MD; Mariana Baseera, MD, MSCI; Roger G Faix, MD; Stephen D Minton, MD; Mark J Sheffield, MD; Carrie A Rau, RN, BSN, CCRC; Karen A Osborne, RN, BSN, CCRC; Shawna Baker, RN; Karie Bird, RN; Laura Cole Bledsoe, RN; Jill Burnett, RNC, BSN; Susan Christensen, RN; Sean D Cunningham, PhD; Brandy Davis, RN, BSN; Jennifer O Elmont, RN, BSN; Becky Hall, APRN; Jennifer J Jensen, RN, BSN; Jamie Jordan, RN, BSN; Mandi C Loertscher, BS, CCRP; Trisha Marchant, RNC, BSN; Earl Maxson, RN, CCRN; Kandace M McGrath, BS; Hena G Mickelsen, BA; Galina Morshed Zadeh, BSN, APRN; D Melody Parry, RN, BSN; Brixen A Reich, RN, MSN; Susan T Schaefer, RN, BSN, RRT; Cynthia Spencer, RNC; Michael Steffen, MS, CPM; Kelly Stout, PhD; Ashley L Stuart, PhD; Katherine Tice, RN, BSN; Kimberlee Weaver-Lewis, RN, MS; Sarah Winter, MD; Kathryn D Woodbury, RN, BSN; Karen Zanetti, RN. Wake Forest University Baptist Medical Center, Brenner Children's Hospital, and Forsyth Medical Center (U10 HD40498, M01 RR7122)—T Michael O’Shea, MD, MPH; Robert G Dillard, MD; Nancy J Peters, RN, CCRP; Korinne Chiu, MA; Deborah Evans Allred, MA, LPA; Donald J Goldstein, PhD; Raquel Hal fond, MA; Barbara G Jackson, RN, BSN; Carroll Peterson, MA; Dia Roberts, BSN, PNP; Ellen L Waldrep, MS; Melissa Whalen Morris, MA; Gail Wiley Hounshell, PhD; Lisa K Washburn, MD; Cherrie D Welch, MD, MPH. Wayne State University, Hutzel Women’s Hospital, and Children’s Hospital of Michigan (UG1 HD21385)—Seetha Shankaran, MD; Beena G Sood, MD, MS; Athina Pappas, MD; John Barks, MD; Yvette R Johnson, MD, MPH; Rebecca Bara, RN, BSN; Laura Goldston, MA; Mary E Johnson, RN, BSN; Deborah Kennedy, RN, BSN; Geraldine Muran, RN, BSN; Elizabeth Billian, RN, MBA; Laura Sumner, RN, BSN; Kara Sawaya, RN, BSN; Eunice Woldt, RN, MSN; Kirsten Childs, RN, MBA; Bogdan Pinnatisect, MD; Prashant Agarwal, MD; Lilia DeJesus, MD; Girija Natarajan, MD; Sanjay Chawla, MD; Mary K Christensen, BA, RRT; Stephanie A Wiggins, MS; Diane White, RRT, CCRP. Yale University, Yale–New Haven Children’s Hospital, and Bridgeport Hospital (U10 HD27871, UL1 TR142, M01 RR125, M01 RR6022)—Richard A Ehrenkranz, MD (deceased); Christine Butler, MD; Harris Jacobs, MD; Patricia Cervone, RN; Nancy Close, PhD; Patricia Getter, RN; Walter Gilliam, PhD; Sheila Greisman, RN; Monica Konstantino, RN, BSN; JoAnn Poulsen, RN; Elaine Romano, MSN; Janet Taft, RN, BSN; Joanne Williams, RN, BSN.
Contributors NSB participated in the conception and design of the study, including the analysis plan and in the interpretation of data, wrote all drafts of the manuscript and helped revise it critically for important intellectual content. NM, ST and AD are the guarantors who participated in designing the analysis plan, were responsible for data management and data analysis, participated in the interpretation of data and helped revise the manuscript critically for important intellectual content. EFB obtained funding, participated in the conception of the study and the interpretation of data, and revised the manuscript critically for important intellectual content. BS, MR, AN, JET and SRH participated in the interpretation of data and helped revise the manuscript critically for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.
Funding NSB is supported by the National Institute on Minority Health and Health Disparities (Award No R01MD016012). For other grant support, see the Acknowledgements section.
Disclaimer While NICHD staff had input into the study design, conduct, analysis and manuscript drafting, the comments and views of the authors do not necessarily represent the views of NICHD, the National Institutes of Health, the Department of Health and Human Services or the US government.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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