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Survival and major neurodevelopmental impairment in extremely low gestational age newborns born 1990-2000: a
Lisa K Washburn1, Robert G Dillard, Donald J Goldstein
1Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA. liwashbu@wfubmc.edu
Insights
Survival rates for extremely low gestational age newborns (ELGANs) increased, while major neurodevelopmental impairment decreased during the 1990s. This study tracked infants born at 23-27 weeks gestation over two distinct five-year periods.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Public Health
Background:
- Extremely low gestational age newborns (ELGANs), born at 23-27 weeks gestation, face significant survival and neurodevelopmental challenges.
- Assessing trends in ELGAN outcomes is crucial for evaluating medical advancements and care improvements over time.
Purpose of the Study:
- To determine if survival rates and the incidence of major neurodevelopmental impairment have changed over time in ELGANs.
- To analyze trends in ELGAN outcomes across two distinct birth epochs during the 1990s.
Main Methods:
- A cohort of ELGANs (23-27 weeks gestation) without congenital anomalies was studied.
- Infants born between 1990-1995 (epoch 1) were compared to those born between 1995-2000 (epoch 2).
- Major neurodevelopmental impairment was defined by cerebral palsy, severe cognitive delay (Bayley Scales), or blindness.
Main Results:
- Survival rates for ELGANs increased from 67% in epoch 1 to 71% in epoch 2.
- The incidence of major neurodevelopmental impairment among survivors decreased from 20% in epoch 1 to 14% in epoch 2.
- Adjusted analyses showed a significant increase in survival (OR 1.5) and a decrease in neurodevelopmental impairment (OR 0.54) from epoch 1 to epoch 2.
Conclusions:
- Survival probability for ELGANs significantly improved during the 1990s.
- The rate of major neurodevelopmental impairment in ELGAN survivors decreased over the same period.
- These findings suggest positive trends in the care and outcomes for extremely premature infants.
Background:
It is important to determine if rates of survival and major neurodevelopmental impairment in extremely low gestational age newborns (ELGANs; infants born at 23-27 weeks gestation) are changing over time.
Methods:
Study infants were born at 23 to 27 weeks of gestation without congenital anomalies at a tertiary medical center between July 1, 1990 and June 30, 2000, to mothers residing in a thirteen-county region in North Carolina. Outcomes at one year adjusted age were compared for two epochs of birth: epoch 1, July 1, 1990 to June 30, 1995; epoch 2, July 1, 1995 to June 30, 2000. Major neurodevelopmental impairment was defined as cerebral palsy, Bayley Scales of Infant Development Mental Developmental Index more than two standard deviations below the mean, or blindness.
Results:
Survival of ELGANs, as a percentage of live births, was 67% [95% confidence interval: (61, 72)] in epoch 1 and 71% (65, 75) in epoch 2. Major neurodevelopmental impairment was present in 20% (15, 27) of survivors in epoch 1 and 14% (10, 20) in epoch 2. When adjusted for gestational age, survival increased [odds ratio 1.5 (1.0, 2.2), p = .03] and major neurodevelopmental impairment decreased [odds ratio 0.54 (0.31, 0.93), p = .02] from epoch 1 to epoch 2.
Conclusion:
The probability of survival increased while that of major neurodevelopmental impairment decreased during the 1990's in this regionally based sample of ELGANs.
