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Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age: the EPI-DAF
Pauline E van Beek1, Monique Rijken2, Lisa Broeders3
1Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands pauline.van.beek@mmc.nl.
Insights
Lowering the gestational age threshold for active treatment in extremely preterm infants to 24 weeks resulted in improved survival. A significant proportion of these survivors showed no neurodevelopmental impairment at school age.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Public Health Policy
Background:
- The Dutch guideline for active treatment of extremely preterm infants was lowered from 25 to 24 weeks' gestation.
- This change led to a 10% increase in survival rates for infants born at this threshold.
Purpose of the Study:
- To describe the neurodevelopmental outcomes at school age for extremely preterm infants born after the guideline change.
- To assess the impact of the lowered gestational age threshold on long-term neurodevelopmental status.
Main Methods:
- A population-based cohort study was conducted in all neonatal intensive care units in the Netherlands.
- Infants born between 24 and 26 weeks' gestation, reaching 5.5 years' corrected age between 2018-2020, were included.
- Neurodevelopmental outcome was assessed using cognitive, neurological, and neurosensory evaluations, defining impairment categories.
Main Results:
- Data from 484 (77%) of 632 survivors were analyzed.
- At 5.5 years corrected age, cognitive and motor scores were generally lower than normative means.
- 46% had no impairment, 36% mild impairment, and 18% moderate-to-severe neurodevelopmental impairment (NDI). NDI-free survival was 30% at 24 weeks, 49% at 25 weeks, and 67% at 26 weeks gestation.
Conclusions:
- Lowering the treatment threshold to 24 weeks' gestation resulted in a substantial number of extremely preterm survivors without neurodevelopmental impairment at school age.
- These findings support the updated guideline, highlighting improved survival alongside a considerable proportion of children achieving favorable neurodevelopmental outcomes.
Objective:
After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks' gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed.
Design:
Population-based cohort study.
Setting:
All neonatal intensive care units in the Netherlands.
Patients:
All infants born between 240/7 and 266/7 weeks' gestation who were 5.5 years' corrected age (CA) in 2018-2020 were included.
Main Outcome Measures:
Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme.
Results:
In the 3-year period, a total of 632 infants survived to 5.5 years' CA. Data were available for 484 infants (77%). At 5.5 years' CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks' gestation, respectively (p<0.001).
Conclusions:
After lowering the threshold for supporting active treatment from 25 to 24 completed weeks' gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years' CA.
