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Published on: November 20, 2015
Changes in long-term survival and neurodevelopmental disability in infants born extremely preterm in the
Rosemarie A Boland1, Jeanie L Y Cheong2, Lex W Doyle3
1Clinical Sciences, Murdoch Children's Research, 50 Flemington Road, Parkville, VIC 3052, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia; Paediatric Infant Perinatal Emergency Retrieval, Royal Children's Hospital, Parkville, VIC, Australia.
Insights
Extremely preterm birth survival has improved, but major neurodevelopmental disability rates in survivors have not. Birthing extremely preterm infants in a specialized tertiary perinatal center can improve outcomes free of disability.
Area of Science:
- Neonatology
- Perinatology
- Developmental Pediatrics
Background:
- Extremely preterm birth (before 28 weeks' gestation) affects <1% of births in high-income countries.
- High rates of mortality and neurodevelopmental disability are associated with extremely preterm birth.
- While survival rates have increased, rates of major neurodevelopmental disability in survivors have not improved in parallel.
Purpose of the Study:
- To highlight the persistent challenge of neurodevelopmental disability in extremely preterm infants.
- To emphasize the importance of specialized perinatal care for improving outcomes.
Main Methods:
- Review of trends in survival and neurodevelopmental outcomes for extremely preterm infants.
- Analysis of the impact of clinical care advancements, such as exogenous surfactant therapy.
- Evaluation of care strategies, including delivery at tertiary perinatal centers.
Main Results:
- Survival rates for extremely preterm infants have increased significantly since the early 1990s.
- Major neurodevelopmental disability rates in survivors have not shown parallel improvement.
- Delivery at a tertiary perinatal center is identified as a key strategy to reduce mortality and disability.
Conclusions:
- Improved survival for extremely preterm infants has not translated to a reduction in major neurodevelopmental disability.
- Specialized care at tertiary perinatal centers is crucial for optimizing outcomes.
- Strategies focusing on improving neurodevelopmental outcomes alongside survival are needed.
Abstract:
Extremely preterm birth before 28 weeks' gestation accounts for less than 1% of births in high-income countries but is associated with high rates of perinatal and infant mortality, and of neurodevelopmental disability in surviving children. Survival rates have increased over time, both overall, and within each week of gestational age since the introduction of exogenous surfactant into clinical care in the early 1990s. However, rates of major neurodevelopmental disability in survivors, whether they be in early childhood or at school-age, have not clearly improved in parallel with the increases in survival. An important strategy to improve survival free of major neurodevelopmental disability is to birth extremely preterm infants in a tertiary perinatal center, where specialist obstetric care for the mother and ongoing intensive care for the infant can both be provided without the potential morbidities associated with postnatal transfer.
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