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Published on: November 20, 2015
Mortality and significant neurosensory impairment in preterm infants: an international comparison
Marie Chevallier1,2, Thierry Debillon3,2, Brian A Darlow4
1Neonatal Intensive Care Unit, Grenoble Alps University Hospital Centre Couples and Children Section, Grenoble, France MChevallier3@chu-grenoble.fr.
Insights
Outcomes for extremely preterm infants varied significantly across three high-income countries, with higher mortality observed in the French cohort (EPIPAGE-2) compared to Australian/New Zealand (ANZNN) and Canadian (CNN/CNFUN) cohorts. These differences highlight potential impacts of varying perinatal practices on infant survival and neurodevelopmental impairment.
Area of Science:
- Neonatalogy
- Perinatal Epidemiology
- Developmental Pediatrics
Background:
- Extremely preterm infants (<28 weeks' gestation) face significant risks of mortality and neurodevelopmental impairment.
- International comparisons are crucial for understanding variations in care and outcomes.
Purpose of the Study:
- To compare mortality and significant neurosensory impairment (sNSI) rates at 18-36 months corrected age.
- To analyze outcomes in extremely preterm infants across three distinct international cohorts.
Main Methods:
- Retrospective analysis of prospectively collected data from three population-based cohorts: ANZNN, CNN/CNFUN, and EPIPAGE-2.
- Inclusion criteria: extremely preterm neonates (<28 weeks' gestation) born in 2011.
- Primary outcome: composite of mortality or sNSI (cerebral palsy, hearing loss, blindness).
Main Results:
- 3055 infants were included. Composite outcome rates were 21.3% (ANZNN), 20.6% (CNN/CNFUN), and 28.4% (EPIPAGE-2).
- Mortality rates were 18.7% (ANZNN), 17.4% (CNN/CNFUN), and 26.3% (EPIPAGE-2).
- EPIPAGE-2 showed significantly higher odds of the composite outcome compared to ANZNN and CNN/CNFUN, primarily driven by higher mortality.
Conclusions:
- Significant differences in mortality and sNSI outcomes exist for extremely preterm infants across high-income countries.
- Variations in perinatal approaches and practices may explain these outcome disparities.
- Further research into best practices is warranted to improve outcomes for this vulnerable population.
Objective:
To compare mortality and rates of significant neurosensory impairment (sNSI) at 18-36 months' corrected age in infants born extremely preterm across three international cohorts.
Design:
Retrospective analysis of prospectively collected neonatal and follow-up data.
Setting:
Three population-based observational cohort studies: the Australian and New Zealand Neonatal Network (ANZNN), the Canadian Neonatal and Follow-up Networks (CNN/CNFUN) and the French cohort Etude (Epidémiologique sur les Petits Ages Gestationnels: EPIPAGE-2).
Patients:
Extremely preterm neonates of <28 weeks' gestation in year 2011.
Main Outcome Measures:
Primary outcome was composite of mortality or sNSI defined by cerebral palsy with no independent walking, disabling hearing loss and bilateral blindness.
Results:
Overall, 3055 infants (ANZNN n=960, CNN/CNFUN n=1019, EPIPAGE-2 n=1076) were included in the study. Primary composite outcome rates were 21.3%, 20.6% and 28.4%; mortality rates were 18.7%, 17.4% and 26.3%; and rates of sNSI among survivors were 4.3%, 5.3% and 3.3% for ANZNN, CNN/CNFUN and EPIPAGE-2, respectively. Adjusted for gestational age and multiple births, EPIPAGE-2 had higher odds of composite outcome compared with ANZNN (OR 1.71, 95% CI 1.38 to 2.13) and CNN/CNFUN (OR 1.72, 95% CI 1.39 to 2.12). EPIPAGE-2 did have a trend of lower odds of sNDI but far short of compensating for the significant increase in mortality odds. These differences may be related to variations in perinatal approach and practices (and not to differences in infants' baseline characteristics).
Conclusions:
Composite outcome of mortality or sNSI for extremely preterm infants differed across high-income countries with similar baseline characteristics and access to healthcare.
