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Has the outcome for extremely low gestational age (ELGA) infants improved following recent advances in neonatal
M Battin1, E W Ling, M F Whitfield
1Department of Pediatrics, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada.
Insights
Survival rates for extremely low-gestational-age (ELGA) infants born at 23-28 weeks improved overall, but only for those born at 26-28 weeks. Infants born at 23-25 weeks showed no significant improvement in survival or neurodevelopmental outcomes.
Area of Science:
- Neonatology
- Perinatal Medicine
- Developmental Pediatrics
Background:
- Advances in neonatal care, including antenatal steroids and surfactant therapy, have aimed to improve outcomes for extremely low-gestational-age (ELGA) infants.
- Previous studies have established baseline survival and neurodevelopmental outcomes for ELGA infants in the pre-surfactant era.
Purpose of the Study:
- To evaluate the survival and neurodevelopmental outcomes of ELGA infants born at 23-28 weeks' gestational age (GA) in a recent cohort (1991-1993).
- To compare these outcomes with an earlier cohort (1983-1989) from the same institution, representing a pre-surfactant era.
- To assess the impact of accepted treatments on survival and neurodevelopmental impairments at 18 months corrected age.
Main Methods:
- Retrospective analysis of perinatal and neonatal data for all births between 23-28 weeks' GA at a tertiary perinatal center.
- Comparison of survival rates to discharge between a recent cohort (n=333) and an earlier cohort (n=911).
- Neurodevelopmental assessment at 18 months corrected age for survivors born at 23-25 weeks' GA in the recent cohort.
Main Results:
- A trend toward improved overall survival to discharge was observed in the recent cohort (72% vs. 65%, p=0.06).
- Improved survival was significant only for infants born at 26-28 weeks' GA (86% vs. 76%, p=0.01), not for those born at 23-25 weeks' GA (44% vs. 44%, p=0.9).
- The incidence of major neurodevelopmental impairment at 18 months corrected age remained high and unchanged (36% in both periods) for infants born at 23-25 weeks' GA.
Conclusions:
- While overall survival showed a trend of improvement, significant gains were limited to later preterm infants (26-28 weeks' GA).
- Neonatal intensive care advancements have not yet translated into improved survival or reduced neurodevelopmental impairment for the most extremely preterm infants (23-25 weeks' GA).
- Further research and interventions are needed to improve outcomes for the most vulnerable ELGA infants born at 23-25 weeks' GA.
Abstract:
The objectives of this paper are to examine (a) the survival of extremely low-gestational-age (ELGA) infants born at 23-28 weeks' gestational age (GA) and (b) the neurodevelopmental outcome at 18 months corrected age for those born at 23-25 weeks' GA during 1991-1993, when antenatal steroids, surfactant, and dexamethasone for bronchopulmonary dysplasia had become accepted treatments; and to compare with an earlier (1983-1989), previously published large cohort (in a presurfactant era) from our institution. Perinatal and neonatal data on all births delivered at 23-28 weeks' GA at British Columbia's tertiary perinatal center were analyzed for survival rates by GA. Survivors of those born at 23-25 weeks' GA underwent neurodevelopmental assessment at a corrected chronological age of 18 months. The recent cohort (n = 333) of live birth infants, compared to the earlier cohort (n = 911 ) showed a trend toward an overall improved survival to discharge (72 vs. 65%, p = 0.06). Further analysis showed that improved survival was seen only in 26- to 28-week GA infants (86 vs. 76%, p = 0.01), but not in 23- to 25-week GA infants (44 vs. 44%, p = 0.9), even when adjusted for gender or twin births. In addition, the incidence of major impairment at 18 months (36% in both periods) remained high. Reanalysis of 24- to 25-week GA infants again showed no evidence of improved survival (53 vs. 50%) or improved outcome at 18 months (major handicap rate 32%; vs. 34%). Survival rates improved for 26- to 28-week GA infants, but the survival rate and incidence of major impairment had not improved for of 23- to 25-week GA infants.