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Published on: November 20, 2015
[Extreme prematurity: comparison of outcome at 5 years depending on gestational age below or above 26 weeks]
Insights
Caring for extremely preterm infants born before 26 weeks gestational age (GW) is challenging. While survivors show similar disability rates at five years, infants born under 26 GW have a higher risk of unfavorable outcomes, including mortality.
Area of Science:
- Neonatalogy and Perinatal Medicine
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Extremely preterm birth, particularly before 26 weeks gestational age (GW), presents significant challenges in neonatal care.
- Understanding the long-term outcomes for these vulnerable infants is crucial for guiding clinical decisions and parental counseling.
Purpose of the Study:
- To compare the 5-year outcomes of two groups of extremely preterm infants: those born at or before 25 weeks + 6 days gestational age (Group 1) and those born between 26 and 27 weeks + 6 days gestational age (Group 2).
- To evaluate the reasonableness of intensive care for infants born at the threshold of viability.
Main Methods:
- A retrospective study analyzed data from 166 extremely preterm infants hospitalized between 1999 and 2001.
- Perinatal data were collected from medical records, and 5-year outcomes (survival, disability) were assessed via questionnaires.
- Infants were categorized by disability (none, minor, major) and progression (favorable/unfavorable).
Main Results:
- Group 1 (<=25 GW+6) had significantly higher mortality (58% vs. 29%), more deaths due to neurological causes, higher rates of intracranial hemorrhage, and more frequent decisions to withdraw care compared to Group 2 (26-27 GW+6).
- Among survivors, no significant difference in disability was observed between the two groups at 5 years.
- However, when including deaths, the risk of unfavorable progression was significantly higher in Group 1 (64% vs. 41%).
Conclusions:
- Infants born extremely preterm at under 26 weeks gestational age experience a more unfavorable progression compared to those born at 26-27 weeks gestational age.
- Despite higher mortality and morbidity in the earliest group, the 5-year prognosis for survivors did not show a significant difference in disability between the two groups, though the overall unfavorable outcome risk remained higher for the <26 GW group.
Objective:
Is it reasonable to care for children born under 26 gestational weeks (GW)? To answer this question, we compared outcome at 5 years of 2 groups of children:less or equal to 25 GW+6 days (group 1) and 26-27 GW+6 days (group 2).
Method:
Retrospective study on extremely preterm children hospitalized in our center between 1999 and 2001. Perinatal data were obtained from medical reports. Five-year outcome was evaluated by questionnaire sent to Centers for Early Medicosocial Intervention, pediatricians or the child's parents. The children were classified according to their disability: none, minor or major. Progression was considered favorable if the child survived with or without minor disability and unfavorable if the child had died or had major disability.
Results:
One hundred and sixty-six preterm babies were recorded. In group 1 (n=63), mortality was higher (58% vs 29%; p=0.0002), a neurologic cause was often responsible for death (36% vs 19%; p=0.018), a high level of intracranial hemorrhage was more frequent (35% vs 19%; p=0.002), and a decision to stop healthcare more often made (35% vs 18%; p=0.01) than in group 2 (n=103). Among the 99 survivors, 78 were being followed up at 5 years of age. In terms of disability, no difference was observed between group 1 (n=21) and group 2 (n=57). Including deaths, the risk for unfavorable progression was higher in group 1 (64% vs 41%; p=0.008).
Conclusion:
The progression of under 26-GW preterm babies is more often unfavorable than the progression of babies born 26-27 GW+6 days. However, given the low number of patients, no significant difference was made concerning the prognosis at 5 years between the survivors of the 2 groups.
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