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Published on: December 31, 2015
The EPIBEL study: outcomes to discharge from hospital for extremely preterm infants in Belgium
Piet Vanhaesebrouck1, Karel Allegaert, Jean Bottu
1Department of Neonatology, University Hospital Ghent, De Pintelaan 185 B-9000 Ghent, Belgium. piet.vanhaesebrouck@ugent.be
Insights
Outcomes for extremely preterm infants born at <=26 weeks gestation are poor. Survival to discharge was 54%, with <15% of survivors free from serious neonatal morbidity.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Critical Care
Background:
- Extremely preterm infants born at <=26 weeks gestation represent a vulnerable population with significant mortality and morbidity risks.
- Understanding discharge outcomes is crucial for parental counseling and clinical decision-making.
Purpose of the Study:
- To determine the mortality and morbidity at hospital discharge for a large population-based cohort of infants born at <=26 weeks gestation.
- To identify factors associated with adverse outcomes in this population.
Main Methods:
- A population-based cohort study was conducted in 19 Belgian perinatal centers.
- Perinatal data were collected for infants alive at the onset of labor between January 1, 1999, and December 31, 2000.
- Survival and major adverse outcomes at discharge were analyzed.
Main Results:
- The overall survival rate for liveborn infants was 54%, with 82% of those alive at 7 days surviving to discharge.
- Factors independently associated with death included vaginal delivery, shorter gestation, air leak, prolonged ventilator dependence, and higher initial oxygen requirement.
- Among survivors, 63% had at least one major adverse outcome (neuromorbidity, chronic lung disease, or retinopathy of prematurity).
- Survival free from serious neonatal morbidity at discharge was less than 15% for infants with gestation <26 weeks.
Conclusions:
- For infants born at <26 weeks gestation, outcome perspectives and treatment options, including nonintervention, should be discussed with parents.
- Discussions should occur within the limits of medical feasibility and appropriateness when pregnancy prolongation is unsuccessful.
Objective:
To determine mortality and morbidity at discharge from the hospital of a large population-based cohort of infants who were born at
Methods:
Perinatal data were collected on extremely preterm infants who were alive at the onset of labor and born between January 1, 1999, and December 31, 2000, in all 19 Belgian perinatal centers.
Results:
A total of 525 infants were recorded. Life-supporting care was provided to 322 liveborn infants, 303 of whom were admitted for intensive care. The overall survival rate of liveborn infants was 54%. Of the infants who were alive at the age of 7 days, 82% survived to discharge. Vaginal delivery, shorter gestation, air leak, longer ventilator dependence, and higher initial oxygen need all were independently associated with death; gender, plurality, and surfactant therapy were not. Among the 175 survivors, 63% had 1 or more of the 3 major adverse outcome variables at the time of discharge (serious neuromorbidity, chronic lung disease at 36 weeks' postmenstrual age, or treated retinopathy of prematurity). The chance of survival free from serious neonatal morbidity at the time of hospital discharge was <15% (21 of 158) for the admitted infants with a gestation <26 weeks.
Conclusions:
If for the time being prolongation of pregnancy is unsuccessful, then outcome perspectives should be discussed and treatment options including nonintervention explicitly be made available to parents of infants of <26 weeks' gestation within the limits of medical feasibility and appropriateness.
