A meta‐analysis of neurodevelopmental outcomes at 4–10 years in children born at 22–25 weeks gestation

Abstract

Aim To update our meta‐analysis on neurodevelopmental disability rates in children born at 22–25 weeks gestation. The main outcome measure was rates of neurodevelopmental disability in survivors at age 4–10 years. Methods We used a peer‐reviewed electronic and grey search to identify articles. Two authors independently reviewed cohorts published after May 2012 with: born ≥1995 in a developed nation; assessed at 4–10 years; prospective; >65% follow‐up; definitions for neurodevelopmental disability as per the EPICure cohort; results reported by gestation. We contacted authors for clarification. Random effects meta‐analysis was used to estimate pooled proportions of neurodevelopmental disability. Within each study, the absolute change in proportions with each week was estimated and then pooled. Results We reviewed 3980 records; 21 articles were assessed and six were included. With the previous 9 cohorts, the meta‐analysis now contains 15. Rates of moderate‐to‐severe neurodevelopmental disability were as follows: 42% (95% CI 23,64%; I2 0%) at 22; 41% (95% CI 31,52%; I2 20%) at 23; 32% (95% CI 25,39%; I2 45%) at 24; 23% (95% CI 18,29%; I2 60%) at 25 weeks. The analysis shows a significant decrease in risk of moderate‐to‐severe neurodevelopmental disability between each week (8.1% (95% CI −11.8, −4.5%); I2 0%; p < 0.001). Conclusion Physicians can use this high‐quality data to support parents during decision‐making.

Neurodevelopmental outcome descriptions in cohorts of extremely preterm children

“…Eligible cohort studies were identified from a recent meta-analysis; the methods are published elsewhere 9 10. In brief, a peer-reviewed search strategy of published and grey literature sources, developed with a librarian, was used to gather studies published between 2005 and 2016 (online supplementary appendix 1).…”

“…In brief, a peer-reviewed search strategy of published and grey literature sources, developed with a librarian, was used to gather studies published between 2005 and 2016 (online supplementary appendix 1). Prospective cohort studies examining neurodevelopmental outcomes of children aged 4–10 years born at 22–25 weeks gestation were eligible for inclusion 9 10. Of 15 eligible cohort studies identified, one study was excluded (no full-text publication), leaving 14 studies in our final sample (online supplementary appendix 2).…”

Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis?

“…If Judy survives, she has approximately 80 more years left to live. If (and at the risk of discriminating on the basis of disability) we further consider the possibility that Judy might survive with severe neurodevelopmental impairment we would estimate that she has a 17% [95% CI: (13%, 22%)] chance of having a life-long severe disability (Ding et al 2019). For Jim, we have no data on his long-term outcomes but respiratory impairments seem to be described.…”

“…The allocation decision would probably be similar if she was born at 22 weeks. If that were the case, she would have a 23% chance of survival (10-50% depending on where she was born) and 42% chance of long-term neuro-morbidity (Backes et al 2019;Ding et al 2019;Rysavy et al 2015). Her chance of survival is probably similar to Jim's (Arentz et al 2020;Weiss and Murdoch 2020;Zhou et al 2020), but Judy would still live longer.…”

Highlights in this issue

“…Readers may also be interested in Ding et al. 's meta‐analysis of neurodevelopmental outcomes of children born at 22–25 weeks of gestation and assessed at 4–10 years.

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