Two-year neurodevelopmental outcome in children born extremely preterm: the EPI-DAF study

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.