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Updated: Oct 1, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Two-year neurodevelopmental outcome in children born extremely preterm: the EPI-DAF study
Pauline E van Beek1, Monique Rijken2, Lisa Broeders3
1Department of Neonatology, Máxima Medical Center, Veldhoven, Noord-Brabant, The Netherlands pauline.van.beek@mmc.nl.
Insights
Lowering the treatment threshold for extremely preterm infants did not increase moderate-to-severe impairment rates. NDI-free survival improved with gestational age, showing better outcomes for infants born at 26 weeks.
Area of Science:
- Neonatal care and outcomes
- Developmental pediatrics
- Public health policy
Background:
- Dutch guidelines lowered the active treatment threshold for extremely preterm infants from 25 to 24 weeks' gestation in 2010.
- The Extremely Preterm Infants - Dutch Analysis on Follow-up Study (EPIDAS) was established to assess outcomes post-guideline change.
Purpose of the Study:
- To evaluate the neurodevelopmental outcomes at 2 years' corrected age (CA) in extremely preterm infants following a guideline change.
- To provide updated national data on survival and impairment rates in this vulnerable population.
Main Methods:
- A national cohort study included live-born infants between 24 and 26 weeks' gestational age, assessed at 2 years' CA (2018-2020).
- Neurodevelopmental impairment (NDI) was determined by cognitive scores (Bayley-III-NL), neurological examination, and neurosensory function.
Main Results:
- Of 991 infants, 651 (66%) survived to 2 years' CA, with data available for 554.
- Overall, 62% had no impairment, 29% mild impairment, and 9% moderate-to-severe impairment (NDI).
- NDI rates were comparable across 24, 25, and 26 weeks' gestation; however, NDI-free survival increased with gestational age (48% at 24 weeks, 75% at 26 weeks). Severe brain injury and low maternal education were associated with higher NDI odds.
Conclusions:
- The guideline change to a lower treatment threshold did not result in a significant increase in moderate-to-severe impairment.
- NDI-free survival improved with increasing gestational age among live-born, NICU-admitted infants.
- This study provides a comprehensive national overview of outcomes for extremely preterm births.
Objective:
In 2010, the Dutch practice regarding initiation of active treatment in extremely preterm infants was lowered from 25 completed weeks' to 24 completed weeks' gestation. The nationwide Extremely Preterm Infants - Dutch Analysis on Follow-up Study was set up to provide up-to-date data on neurodevelopmental outcome at 2 years' corrected age (CA) after this guideline change. Design: National cohort study.
Patients:
All live born infants between 240/7 weeks' and 266/7 weeks' gestational age who were 2 years' CA in 2018-2020.
Main Outcome Measure:
Impairment at 2 years' CA, based on cognitive score (Bayley-III-NL), neurological examination and neurosensory function.
Results:
651 of 991 live born infants (66%) survived to 2 years' CA, with data available for 554 (85%). Overall, 62% had no impairment, 29% mild impairment and 9% moderate-to-severe impairment (further defined as neurodevelopmental impairment, NDI). The percentage of survivors with NDI was comparable for infants born at 24 weeks', 25 weeks' and 26 weeks' gestation. After multivariable analysis, severe brain injury and low maternal education were associated with higher odds on NDI. NDI-free survival was 48%, 67% and 75% in neonatal intensive care unit (NICU)-admitted infants at 24, 25 and 26 weeks' gestation, respectively.
Conclusions:
Lowering the threshold has not been accompanied by a large increase in moderate-to-severely impaired infants. Among live-born and NICU-admitted infants, an increase in NDI-free survival was observed from 24 weeks' to 26 weeks' gestation. This description of a national cohort with high follow-up rates gives an accurate description of the range of outcomes that may occur after extremely preterm birth.
