Survival rates for babies born extremely prematurely increased between 1995 and 2006, but few improvements in neonatal morbidity occurred despite appropriate interventions. The current study was undertaken to examine the neurologic and developmental outcomes for babies born at less than 27 weeks' gestation in 2006 and to compare the survival and outcomes at 3 years of age with those of babies born at 22 to 25 weeks' gestation in 1995.Data were collected for all babies born at 22 to 26 weeks' gestation during 2006. Families were contacted for assessment when the children were aged 30 to 36 months. In 1995, data were collected for babies born at 22 to 25 weeks' gestation. Cerebral palsy was identified by neurologic examination and classified as severe, moderate, and mild, or no impairment in motor, developmental, sensory, and communication domains. Data from these 1995 and 2006 cohorts were combined to allow comparisons after reclassification of 2006 outcomes using the 1995 definitions.A total of 576 children, aged 27 to 48 months, were evaluated in person. Information was available from local data records for another 191 children, aged 18 to 50 months, of whom 68 (38%) had neurodevelopmental impairment. Of babies born at less than 27 weeks' gestation in 2006, 77 (13.4%) had severe, and 68 (11.8%) had moderate impairment. Rates for cognitive, communication, and motor impairment were 16%, 11%, and 8%, respectively. An inverse relationship was observed between gestational age and prevalence of moderate or severe impairment, that is, 45% of survivors at 22 to 23 weeks to 30% at 24 weeks, 25% at 25 weeks, and 20% at 26 weeks. Eighty-three children had cerebral palsy, 32 (39%) with diplegia, 21 (25%) with hemiplegia, 10 (12%) with quadriplegia, and 20 (24%) with other types. Nine children (11%) with cerebral palsy had severe sensory impairment; developmental testing showed severe, moderate, or mild impairment in 47 (57%), 30 (46%), and 6 (7%) children, respectively. For births at less than 27 weeks' gestation in 2006, survival free of moderate or severe impairment ranged from 8% at 23 weeks' gestation to 59% at 26 weeks' gestation. Based on babies who received active intervention after birth, rates ranged from 11% at 23 weeks' gestation to 60% at 26 weeks' gestation and for babies receiving intensive care from 15% to 61%, respectively.When comparing to the historical cohort, survival to age 3 years for babies admitted to intensive care was 39% in 1995 and 52% in 2006. Overall, the proportion of babies admitted to intensive care who survived with severe disability increased by 2.6%, but a higher proportion survived without disability (11%). Survival without disability increased significantly at 25 and 24 weeks' gestation (15% and 10%, respectively), but changes were not statistically significant at 23 and 22 weeks' gestation (2.5% and j0.4%). In 1995, 43 children (18%) had severe disabilities, and 54 (23%) had other disabilities compared with 60 (19%) and 54 (16%), respectively, in 2006. Developmental scores of ...

Objective To determine survival and neonatal morbidity for babies born between 22 and 26 weeks' gestation in England during 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks' gestation.Design Prospective national cohort studies. Setting Maternity and neonatal units in England.Participants 3133 Main outcome measures Survival to discharge from hospital, pregnancy and delivery outcomes, infant morbidity until discharge. ResultsIn 2006, survival of live born babies was 2% (n=3) for those born at 22 weeks ' gestation, 19% (n=66) at 23 weeks, 40% (n=178) at 24 weeks, 66% (n=346) at 25 weeks, and 77% (n=448) at 26 weeks (P<0.001). At discharge from hospital, 68% (n=705) of survivors had bronchopulmonary dysplasia (receiving supplemental oxygen at 36 weeks postmenstrual age), 13% (n=135) had evidence of serious abnormality on cerebral ultrasonography, and 16% (n=166) had laser treatment for retinopathy of prematurity. For babies born between 22 and 25 weeks' gestation from March to December, the number of admissions for neonatal care increased by 44%, from 666 in 1995 to 959 in 2006. By 2006 adherence to evidence based practice associated with improved outcome had significantly increased. Survival increased from 40% to 53% (P<0.001) overall and at each week of gestation: by 9.5% (confidence interval −0.1% to 19%) at 23 weeks, 12% (4% to 20%) at 24 weeks, and 16% (9% to 23%) at 25 weeks. The proportions of babies surviving in 2006 with bronchopulmonary dysplasia, major cerebral scan abnormality, or weight and/or head circumference <−2 SD were similar to those in 1995, but the proportion treated for retinopathy of prematurity had increased from 13% to 22% (P=0.006). Predictors of mortality and morbidity were similar in both cohorts. ConclusionSurvival of babies born between 22 and 25 weeks' gestation has increased since 1995 but the pattern of major neonatal morbidity and the proportion of survivors affected are unchanged. These observations reflect an important increase in the number of preterm survivors at risk of later health problems. IntroductionPreterm birth is associated with increased rates of neonatal mortality and long term morbidities such as respiratory problems, learning difficulties, cerebral palsy, and behavioural problems, that are highest in the most immature.1 2 This is an important public health issue as rates of preterm birth are rising in many European countries and are particularly high in the United Kingdom. 3 The first EPICure study collected data for all births in the UK and Ireland before 26 completed weeks' gestation for 10 months in 1995, 4 with detailed information for those babies admitted for intensive care. Outcomes for surviving RESEARCHchildren have been reported to the age of 11. 5 Since 1995 there has been emphasis on several evidence based interventions to reduce neonatal morbidity. These include increased use of antenatal corticosteroids to promote lung maturation, 6 strategies to avoid neonatal hypothermia at birth, 7 increased use...

Objective To review all late terminations of pregnancy, between 22 +0 and 26 +6 weeks of gestation, collected as part of the EPICure2 study.Design Prospective cohort study.Setting All National Health Service (NHS) hospitals providing perinatal services for extremely preterm infants.Population All births between 22 +0 and 26 +6 weeks of gestation in England during 2006.Methods Data were collected for the defined cohort of births, including terminations of pregnancy, by designated unit staff using a standardised questionnaire. Rigorous validation processes were established to ensure comprehensive data collection. Gestational age was validated using a hierarchical classification of scan dates, certain date of last menstrual period and working gestation. Data for terminations of pregnancy (TOPs) were categorised into two groups, terminations for fetal abnormality and for maternal or fetal compromise, and were analysed in terms of their reporting, management and outcomes. Conclusion Terminations of pregnancy represent a relatively large proportion of very preterm births. Fetal abnormalities are the main cause for these terminations, and most include feticide. Better screening strategies are required to avoid the need for late terminations of pregnancy for fetal abnormalities.

Background Children born extremely preterm have poor growth attainment; it is not known whether recent advances in neonatal care have led to an improvement. Aim To compare SD scores of growth parameters at 35 months corrected age for children born ≤25 weeks in England in 1995 (EPICure) and 2006 (EPICure-2). Methods Measures of height (ht), weight (wt), head circumference (HC) and mid upper arm circumference (MUAC) were taken as part of a neurodevelopmental assessment. Body mass index (BMI) and SD scores were calculated using British Growth Foundation normative data. Results In 2006 325/586 (55%) of survivors ≤25 week were seen, of whom 98% had growth measures. Weight, height, MUAC and BMI were all significantly improved at 35 months corrected age compared to the 1995 EPICure cohort (table 1). There was no significant difference in HC. Improvement in weight gain was due to greater post-discharge growth. Abstract PB.01 Table 1Comparison of growth SD scores at 2.5-3 years n EPICure (1995) n EPICure2 (2006) p Wt 223 −1.19 (−1.37, −1.02) 317 −0.67 (−0.82, −0.52) <0.001 HC 229 −1.64 (−1.83, −1.45) 319 −1.78 (−1.94, −1.61) 0.29 Ht 214 −0.65 (−0.83, −0.49) 303 −0.40 (−0.57, −0.23) <0.05 BMI 209 −1.06 (−1.25, −0.87) 301 −0.59 (−0.78, −0.40) <0.001 MUAC 229 −0.74 (−0.87, −0.62) 314 −0.43 (−0.52, −0.33) <0.001 Conclusion There has been a significant improvement since 1995 in all growth parameters except HC at 35 months corrected age. Improved weight gain at 35 months was attributable to post-discharge catch-up growth.