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Functional abilities at age 4 years of children born before 29 weeks of gestation
A Johnson1, P Townshend, P Yudkin
1National Perinatal Epidemiology Unit, Radcliffe Infirmary, Oxford.
Insights
Very preterm infants born before 29 weeks gestation face high rates of disability. Lower gestational age at birth significantly increases the risk of impairment and disability in survivors.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Public Health
Background:
- Infant survival rates for extremely preterm births have been increasing.
- There is a need to understand the long-term outcomes for these vulnerable infants.
Purpose of the Study:
- To determine the incidence of impairment and disability in infants born very preterm.
- To examine the relationship between gestational age at birth and the likelihood of impairment.
Main Methods:
- A cohort study was conducted on a geographically defined population.
- Infants born alive before 29 weeks gestation between 1984-1986 were included.
- Outcomes assessed at 4 years of age included survival, impairment, and disability.
Main Results:
- Half of the 342 infants survived to discharge; 164 survived to age 4.
- Among survivors assessed at age 4, 23% had severe disabilities and 35% were unimpaired.
- A statistically significant increase in impairment and disability was observed with lower gestational age (p < 0.003).
Conclusions:
- As more extremely preterm infants survive, effective monitoring systems for disabilities are crucial.
- Early identification and intervention strategies are needed for preterm survivors.
Objectives:
To assess the rate of impairment and disability among babies born very preterm and to investigate the association between such impairment and gestational age at birth.
Design:
Cohort study of a geographically defined population of babies.
Setting:
Oxford Regional Health Authority.
Subjects:
All babies born alive before 29 weeks of gestation to mothers resident in the region during 1984-6.
Main Outcome Measures:
Survival rates and rates of impairment and disability among survivors at the age of 4 years.
Results:
Of the 342 babies, half (170) survived to be discharged home. Of the 164 survivors to age 4 years, 153 (93%) were assessed. A total of 35 (23%; 95% confidence interval 16% to 30%) were severely disabled and only 54 (35%; 28% to 43%) were unimpaired. The risk of impairment and disability increased with decreasing gestational age at birth (p < 0.003).
Conclusions:
With the increasing survival rate among babies born before 29 weeks of gestation, we need urgently to establish reliable ways of monitoring the proportion of survivors who have a disability.