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Survival and 2-year outcome of extremely preterm infants
Insights
Infants born between 24-28 weeks gestation have varying survival rates. While mortality is higher for earlier gestations, survivors show similar rates of functional handicap and normal development at two years old.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Neurology
Background:
- Premature birth, especially before 28 weeks gestation, poses significant risks to infant survival and long-term health.
- Understanding the outcomes for extremely preterm infants is crucial for clinical management and parental counseling.
Purpose of the Study:
- To evaluate the survival rates and neurodevelopmental outcomes at two years of age for infants born between 24 and 28 weeks gestation.
- To compare the outcomes of infants born at 24-26 weeks with those born at 27-28 weeks gestation.
Main Methods:
- Retrospective analysis of 163 infants born between 24-28 weeks gestation over a 4.5-year period.
- Exclusion of infants with congenital anomalies to focus on otherwise healthy preterm infants.
- Assessment of survival at hospital discharge and neurodevelopmental status at two years corrected age.
Main Results:
- Hospital survival rates increased with gestational age, ranging from 36% at 24 weeks to 74% at 28 weeks.
- Infants born at 24-26 weeks had a significantly higher mortality rate (57%) compared to those born at 27-28 weeks (34%).
- However, among survivors, the rates of significant functional handicap (11% vs 10%) and normal development (32% vs 56%) were not statistically different between the two groups at two years of age.
Conclusions:
- While extremely preterm birth (24-26 weeks) carries a higher mortality risk, survivors demonstrate comparable rates of functional disability and developmental progress to those born slightly later (27-28 weeks).
- This suggests that intensive neonatal care can mitigate some long-term morbidities associated with very early preterm birth.
Abstract:
The survival of 163 infants born within the hospital at 24-28 weeks gestation during a 4 1/2-year period and the morbidity in survivors at 2 years of age were reported. Hospital survival rates from 24-28 weeks at each week of gestation, excluding six infants with birth defects, were 36%, 32%, 57%, 70% and 74% respectively. The late outcome of children born at 24-26 weeks was compared with those born at 27-28 weeks. Of the 81 infants in the former group 46 (57%) died, nine (11%) survived with significant functional handicap and 26 (32%) were developing within the normal range. Of the 82 infants in the latter group, 28 (34%) died, eight (10%) survived with significant functional handicap and 46 (56%) were developing within the normal range. Although the mortality rate was significantly higher in the 24-26-weeks group, the physical disability and functional handicap rates in survivors were not statistically different between the two groups. Neither was developmental progress, as determined by psychological assessment, different.