Objective To determine outcomes at age 3 years in babies born before 27 completed weeks' gestation in 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks' gestation.Design Prospective national cohort studies, EPICure and EPICure 2. Setting Hospital and home based evaluations, England.Participants 1031 surviving babies born in 2006 before 27 completed weeks' gestation. Outcomes for 584 babies born at 22-25 weeks' gestation were compared with those of 260 surviving babies of the same gestational age born in 1995.Main outcome measures Survival to age 3 years, impairment (2008 consensus definitions), and developmental scores. Multiple imputation was used to account for the high proportion of missing data in the 2006 cohort. ResultsOf the 576 babies evaluated after birth in 2006, 13.4% (n=77) were categorised as having severe impairment and 11.8% (n=68) moderate impairment. The prevalence of neurodevelopmental impairment was significantly associated with length of gestation, with greater impairment as gestational age decreased: 45% at 22-23 weeks, 30% at 24 weeks, 25% at 25 weeks, and 20% at 26 weeks (P<0.001). Cerebral palsy was present in 83 (14%) survivors. Mean developmental quotients were lower than those of the general population (normal values 100 (SD 15)) and showed a direct relation with gestational age: 80 (SD 21) at 22-23 weeks, 87 (19) at 24 weeks, 88 (19) at 25 weeks, and 91 (18) at 26 weeks. These results did not differ significantly after imputation. Comparing imputed outcomes between the 2006 and 1995 cohorts, the proportion of survivors born between 22 and 25 weeks' gestation with severe disability, using 1995 definitions, was 18% (95% confidence interval 14% to 24%) in 1995 and 19% (14% to 23%) in 2006. Fewer survivors had shunted hydrocephalus or seizures. Survival of babies admitted for neonatal care increased from 39% (35% to 43%) in 1995 to 52% (49% to 55%) in 2006, an increase of 13% (8% to 18%), and survival without disability increased from 23% (20% to 26%) in 1995 to 34% (31% to 37%) in 2006, an increase of 11% (6% to 16%). ConclusionSurvival and impairment in early childhood are both closely related to gestational age for babies born at less than 27 weeks' gestation. Using multiple imputation to account for the high proportion of missing values, a higher proportion of babies admitted for neonatal care now survive without disability, particularly those born at gestational ages 24 and 25 weeks. IntroductionThe survival of babies born at extremely low gestational ages increased in England between 1995 and 2006 but there were few improvements in neonatal morbidity. 1 Indeed, higher survival rates were reported in the Swedish population study, EXPRESS (Extremely Preterm Infants in Sweden Study), 2 yet the proportions of survivors without major neonatal morbidity was similar to those in this, the EPICure 2 study, and described in the accompanying paper.1 This is despite the widespread introduction of interventions to improve outcomes such as the ...

Background:As the latest edition of the Bayley Scales (Bayley-III) produces higher scores than its predecessor (BSID-II), there is uncertainty about how to classify moderate-severe neurodevelopmental delay. We have investigated agreement between classifications of delay made using the BSID-II and Bayley-III. Methods: BSID-II Mental Development Index (MDI) and Bayley-III cognitive and language scales were administered in 185 extremely preterm (<27 wk) children. A combined Bayley-III score (CB-III) was computed. Agreement between delay classified using MDI scores <70 and various Bayley-III cut-offs was assessed. results: Bayley-III cognitive and language scores were close to the normative mean and were higher than BSID-II MDI scores. Nineteen (10.2%) children had MDI <70. Bayley-III scores <70 significantly underestimated the proportion with MDI <70. Bayley-III cognitive and language scores <85 had 99% agreement with MDI <70 and underestimated delay by 1.1%. CB-III scores <80 had 98% agreement and produced the same proportion with delay. conclusion: Bayley-III cognitive and language scores <85 or CB-III scores <80 provide the best definition of moderatesevere neurodevelopmental delay for equivalence with MDI <70. CB-III scores have the advantage of producing a single continuous outcome measure but require further validation. The relative accuracy of both tests for predicting long-term outcomes requires investigation.

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AIM The aim of this article was to report the prevalence of, and risk factors for, positive autism screens using the Modified Checklist for Autism in Toddlers (M-CHAT) in children born extremely preterm in England.METHOD All children born at not more than 26 weeks' gestational age in England during 2006 were recruited to the EPICure-2 study. At 2 years of age, postal questionnaires incorporating the M-CHAT and additional developmental questions were sent to the parents of each survivor (n=1031; 499 male, 532 female), of which 523 (266 male, 257 female; 51%) were returned completed. RESULTSThe prevalence of positive M-CHAT screens in this extremely preterm population was 41% (216 ⁄ 523; 130 male; 86 female). Severe bronchopulmonary dysplasia, administration of postnatal steroids, late-onset bacteraemia, and being male were statistically significantly associated with a positive screen. Coexisting disabilities were present in 320 (62%) children. Of 200 children without disability, 16.5% screened positive. In contrast, 63 (95.5%) of those with severe motor impairment (odds ratio 42; 95% confidence interval [CI] 12.9-135) and 175 (55.9%) of those with cognitive impairment (odds ratio 5.3; CI 3.5-8) screened positive. All children with a significant vision or hearing impairment screened positive. INTERPRETATIONThe prevalence of positive M-CHAT screens in extremely preterm children is high, especially in children with neurodevelopmental impairment. Positive screens should be interpreted in the light of other neurodevelopmental sequelae in clinical practice to avoid falsepositive referrals.Preterm birth is an established risk factor for psychiatric disorders including autism spectrum disorders (ASDs). In a recent whole-population study, we reported that 8% of 219 children born at not more than 25 completed weeks of gestation met the diagnostic criteria for ASD in middle childhood. 1,2 This is markedly higher than the 0.2 to 0.7% prevalence reported in the general population. 3,4 As early diagnosis and behavioural intervention for ASD significantly improves outcome, 5,6 screening may be particularly important in high-risk groups such as extremely preterm children. The advent of autism screening tools, such as the Modified Checklist for Autism in Toddlers (M-CHAT), 7 has facilitated screening in infancy, and the use of this parentreport questionnaire is increasing in both clinical and research outcome evaluations. A high prevalence of positive autism screens in extremely preterm infants has been reported in selected American cohorts, 8,9 but concerns have been raised regarding the interpretation of such results in light of the high prevalence of other neurodevelopmental impairments. 8,10 In order to advance our understanding of screening for early symptoms of autism in extremely preterm children, we used the M-CHAT in a postal questionnaire format as part of a national population-based study of extremely preterm infants born in England. We investigated the prevalence of and neurodevelopmental associations with positiv...

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 −0.4%). 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 55 or les...