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Neonatal survival and disability rate at age 18 months for infants born between 23 and 28 weeks of gestation
F Lefebvre1, J Glorieux, T St-Laurent-Gagnon
1Neonatal Service and Research Center, Hôpital Ste-Justine, Université de Montréal, Canada.
Insights
Surfactant use significantly improved survival rates for premature infants born between 24 and 28 weeks gestation. Most survivors showed normal development by 18 months corrected age.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Outcomes Research
Background:
- Surfactant therapy has revolutionized the care of preterm infants.
- Understanding gestational age-specific outcomes is crucial for optimizing neonatal intensive care.
Purpose of the Study:
- To evaluate the impact of surfactant use on gestational age-specific outcomes in very preterm infants.
- To determine survival rates and neurodevelopmental status in infants born between 23 and 28 weeks gestation during the surfactant era.
Main Methods:
- Prospective analysis of 465 consecutive births between 23 and 28 weeks gestation (1987-1992).
- Follow-up at 18 months corrected age for 217 survivors (85% of total survivors).
- Assessment of survival rates and neurodevelopmental quotients (DQ).
Main Results:
- Significant increase in survival rates observed for infants born at 24 weeks (0% to 33%), 25-26 weeks (38% to 71%), and 27-28 weeks (66% to 84%) gestation between 1987-1988 and 1991-1992.
- Incidence of normality at 18 months corrected age ranged from 44% to 76% across gestational age groups.
- Mean developmental quotients were largely similar across gestational age groups, ranging from 89 to 96.
Conclusions:
- Gestational age remains a primary determinant of survival in very preterm infants.
- Surfactant therapy is associated with improved survival rates for infants born at 24-28 weeks gestation.
- A majority of survivors demonstrated normal neurodevelopmental outcomes by 18 months corrected age.
Objective:
Our purpose was to determine gestational age-specific outcomes of infants born in a period of surfactant use.
Study Design:
All 465 consecutive births between 23 and 28 weeks' gestation in a tertiary center from 1987 to 1992 were analyzed prospectively. At 18 months' corrected age, 217 of 254 (85%) survivors were evaluated.
Results:
From 1987 and 1988 to 1991 and 1992 there was an increase in survival for infants born at 24 weeks (from 0% to 33% p = 0.17), 25 to 26 weeks (38% to 71%, p < 0.005), and 27 to 28 weeks (66% to 84%, p < 0.05). At each weekly interval from 24 to 28 weeks of gestation the respective incidence of normality was 44%, 71%, 57%, 76% and 72% (not significant) and the respective mean developmental quotient was 91 +/- 17, 89 +/- 25, 90 +/- 24, 96 +/- 15 and 96 +/- 14 (not significant).
Conclusions:
Gestational age was strongly associated with outcome in terms of survival. Overall, 70% of children followed up were developing within the normal range.