Survival and long-term neurodevelopmental outcome of the extremely preterm infant. A systematic review

Survival rates among live births in North American tertiary perinatal centers since 1990 were 28% at 23 weeks, 52% at 24, 70% at 25 and 83% at 26 weeks. However, there is wide variation among centers. Survival rates in 2010 among tertiary centers in the United States participating in the Vermont-Oxford Network were 34% at 23 weeks, 61% at 24, 79% at 25, and 87% at 26. All reports of neurodevelopmental outcome of extremely preterm infants in the English literature were reviewed. This literature is very heterogeneous and prevalence highly variable. Major limitations are astonishing variation in criteria for major disability and that, even with the same disability criteria, children with major disabilities are functionally very heterogeneous. Mean prevalence of disability in the literature is 36%, but ranges from 10-61%. This literature could be improved if survivors were followed until early school age, there were more uniform reporting by week of gestation, and outcomes of term control groups were included.