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Intensity of perinatal care for extreme preterm births and neurodevelopmental outcomes at age 5½: the EPIPAGE-2

Andrei Scott Morgan1,2, Laetitia Marchand-Martin3, Sabrina Twilhaar4

  • 1Obstetric, Perinatal, Paediatric and Lifecourse Epidemiology (OPPaLE) team, Centre for Research in Epidemiology and Statistics (CRESS) UMR1153, INSERM, Paris, France andrei.morgan@inserm.fr.

BMJ Paediatrics Open
|July 5, 2025
PubMed

Insights

Survival-focused perinatal care for extremely preterm infants did not increase long-term neurodevelopmental disabilities (NDDs). Higher intensity care was linked to better outcomes for those born at 24-26 weeks gestation.

Area of Science:

  • Neonatalogy
  • Perinatal Medicine
  • Developmental Pediatrics

Background:

  • Preterm birth, especially before 29 weeks gestation, poses significant risks for long-term neurodevelopmental disabilities (NDDs).
  • The intensity of perinatal care, often termed 'survival-focused,' aims to improve outcomes for extremely preterm infants.
  • Concerns exist regarding potential adverse long-term effects of intensive perinatal care on neurodevelopment.

Purpose of the Study:

  • To evaluate the association between the intensity of perinatal care and neurodevelopmental outcomes at 5.5 years in survivors born at 24-26 and 27-28 weeks gestation.
  • To determine if higher intensity 'survival-focused' care is linked to increased or decreased rates of NDDs in these vulnerable populations.

Main Methods:

  • A prospective, population-based national cohort study was conducted in France in 2011.
  • The study included children surviving to 5.5 years who were born at less than 29 weeks gestation.
  • Perinatal care intensity was categorized at the hospital level based on specific admission and delivery ratios for extremely preterm infants.

Main Results:

  • Among 3217 births, 472 infants born at 24-26 weeks and 633 at 27-28 weeks survived to 5.5 years.
  • For infants born at 24-26 weeks, high-intensity care hospitals showed the lowest rates of mild and moderate-severe NDDs compared to low-intensity hospitals (ORs 0.42 and 0.47, respectively).
  • No significant differences in NDDs were observed between low and medium intensity care hospitals for the 24-26 week group, nor between any intensity levels for the 27-28 week gestation group.

Conclusions:

  • The study found no evidence to support concerns that intensive perinatal care is associated with increased long-term neurodevelopmental disabilities in extremely preterm infants.
  • High-intensity perinatal care may be associated with better neurodevelopmental outcomes for infants born at the earliest gestations (24-26 weeks).
  • Gestational age appears to be a critical factor, with no observed impact of care intensity on NDDs for infants born at 27-28 weeks gestation.
Abstract

Keywords:
EpidemiologyInfantNeonatology

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