Increased survival and deteriorating developmental outcome in 23 to 25 week old gestation infants, 1990-4 compared with 1984-9

Emsley, Hedley; Wardle, S P; Sims, D G; Chiswick, ML; D'Souza, S W

doi:10.1136/fn.78.2.f99

Cited by 166 publications

(88 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…9 Over recent years, trials focused on evaluating the prognosis for child development have generally been conducted in developed countries and have included infants with birth weight under 1500 g, and particularly those with less than 32 weeks of gestation. [25][26][27] However, whether low birth weight is due to prematurity or IGR, it constitutes a risk factor for developmental abnormalities. This association is particularly frequent under unfavorable social conditions.…”

Section: Resultsmentioning

confidence: 99%

Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic

2008

View full text Add to dashboard Cite

CONTEXT AND OBJECTIVE: Knowledge of risk factors associated with child development disorders is essential for delivering high-quality childcare. The objective here was to evaluate the relationships between risk factors and occurrences of developmental abnormalities among children attended at a reference clinic for children at risk of developmental abnormalities. DESIGN AND SETTING: Retrospective study at a multidisciplinary reference center, Embu, São Paulo. METHODS: All cases followed up for more than three months between 1995 and 2003 were reviewed. The risk factors assessed were low birth weight, gestational age, length of stay in neonatal ward, perinatal asphyxia, mother’s age < 18 years, congenital infections, malformations and low mother’s education level. Developmental abnormalities were defined according to developmental tests and assessments by the clinic’s professionals. The statistical analysis consisted of the chi-squared test for comparing categorical variables and a logistic regression model for multivariate analysis. RESULTS: 211 children were followed up for more than three months. Developmental abnormalities occurred in 111 (52.6%). Univariate analysis showed significant relationships between developmental abnormality and low birth weight, perinatal asphyxia, length of stay > 5 days, prematurity and mother’s age 18 years and older. Low birth weight, history of perinatal asphyxia and mother’s age continued to be significant in multivariate analysis. CONCLUSIONS: Special attention must be paid to the development of low birth weight infants and/or infants with histories of neonatal complications. Low birth weight is easily assessed and should be considered to be an important marker when defining guidelines for following up child development.

show abstract

Section: Resultsmentioning

confidence: 99%

Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic

2008

View full text Add to dashboard Cite

show abstract

“…A rise in neonatal morbidity and later disability in childhood with improved survival leading to no significant change in the number of normal survivors (16% vs 14%) as the proportion of the original population was observed recently as an alarming development comparing the outcome of 192 EPT infants in a large single-center study during an 11-year period. 34 Near universal initiation of intensive care in a population-based cohort of EPT infants (23)(24)(25)(26) weeks' gestation) who were born during the mid1980s in central New Jersey (n ϭ 146), compared with selective initiation of intensive care for a comparable group of EPT infants in the Netherlands (n ϭ 141),…”

Section: Discussionmentioning

confidence: 99%

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

Vanhaesebrouck

Allegaert²,

Bottu³

et al. 2004

Pediatrics

182

123

View full text Add to dashboard Cite

ABSTRACT. Objective. To determine mortality and morbidity at discharge from the hospital of a large population-based cohort of infants who were born at <26 weeks' gestation.Methods. Perinatal data were collected on extremely preterm infants who were alive at the onset of labor and born between January 1, 1999, and December 31, 2000, in all 19 Belgian perinatal centers.Results. A total of 525 infants were recorded. Lifesupporting care was provided to 322 liveborn infants, 303 of whom were admitted for intensive care. The overall survival rate of liveborn infants was 54%. Of the infants who were alive at the age of 7 days, 82% survived to discharge. Vaginal delivery, shorter gestation, air leak, longer ventilator dependence, and higher initial oxygen need all were independently associated with death; gender, plurality, and surfactant therapy were not. Among the 175 survivors, 63% had 1 or more of the 3 major adverse outcome variables at the time of discharge (serious neuromorbidity, chronic lung disease at 36 weeks' postmenstrual age, or treated retinopathy of prematurity). The chance of survival free from serious neonatal morbidity at the time of hospital discharge was <15% (21 of 158) for the admitted infants with a gestation <26 weeks.Conclusions. If for the time being prolongation of pregnancy is unsuccessful, then outcome perspectives should be discussed and treatment options including nonintervention explicitly be made available to parents of infants of <26 weeks' gestation within the limits of medical feasibility and appropriateness. Pediatrics 2004; 114:663-675; extreme prematurity, mortality, morbidity, population-based cohort.

show abstract

“…9,21,23,28 -30 More active treatment, ie, cesarean section and active resuscitation, of these infants does not always improve the outcome, 30 although surfactant treatment has been found beneficial. 31 The study by Emsley et al 9 showed improved survival of infants born at 23 to 25 GWs between 1984 and 1994 but showed a significant rise in disability rates. The deteriorated outcome was primarily caused by visual impairments, whereas the incidence of cerebral palsy remained constant.…”

Section: Figmentioning

confidence: 99%

“…Thus, the total number of children born extremely immature and surviving with long-term disability increased. 8,9 During the 1990s, new advances in care, such as antenatal steroid treatment to mothers with threatening premature labor, surfactant treatment to infants with respiratory distress syndrome (RDS), and new modes of respiratory support, all known to decrease the mortality of ELBW infants, have become widely used in developed countries. From this period, there are scarce data on long-term follow-up.…”

mentioning

confidence: 99%

A National Short-Term Follow-Up Study of Extremely Low Birth Weight Infants Born in Finland in 1996–1997

Heinonen²,

et al. 2001

View full text Add to dashboard Cite

ABSTRACT. Objectives. The aims of this prospective nationwide investigation were to establish the birth rate, mortality, and morbidity of extremely low birth weight (ELBW) infants in Finland in 1996 -1997, and to analyze risk factors associated with poor outcome.Participants and Methods. The study population included all stillborn and live-born ELBW infants (birth weight: <1000 g; gestational age: at least 22 gestational weeks [GWs]), born in Finland between January 1, 1996 and December 31, 1997. Surviving infants were followed until discharge or to the age corresponding with 40 GWs. National ELBW infant register data with 101 prenatal and postnatal variables were used to calculate the mortality and morbidity rates. A total of 32 variables were included in risk factor analysis. The risk factors for death and intraventricular hemorrhage (IVH) of the live-born infants as well as for retinopathy of prematurity (ROP) and oxygen dependency of the surviving infants were analyzed using logistic regression models.Results. A total of 529 ELBW infants (.4% of all newborn infants) were born during the 2-year study. The perinatal mortality of ELBW infants was 55% and accounted for 39% of all perinatal deaths. Of all ELBW infants, 34% were stillborn, 21% died on days 0 through 6, and 3% on days 7 though 28. Neonatal mortality was 38% and postneonatal mortality was 2%. Of the infants who were alive at the age of 4 days, 88% survived. In infants surviving >12 hours, the overall incidence of respiratory distress syndrome (RDS) was 76%; of blood culture-positive septicemia, 22%; of IVH grades II through IV, 20%; and of necrotizing enterocolitis (NEC) with bowel perforation, 9%. The rate of IVH grades II through IV and NEC with bowel perforation decreased with increasing gestational age, but the incidence of RDS did not differ significantly between GWs 24 to 29. A total of 5 infants (2%) needed a shunt operation because of posthemorrhagic ventricular dilatation. Two hundred eleven ELBW infants (40% of all and 60% of live-born infants) survived until discharge or to the age corresponding with 40 GWs. The oxygen dependency rate at the age corresponding to 36 GWs was 39%, and 9% had ROP stage III-V. Neurological status was considered completely normal in 74% of the surviving infants. The proportions of infants born at 22 to 23, 24 to 25, 26 to 27, and 28 to 29 GWs with at least one disability (ROP, oxygen dependency, or abnormal neurological status) at the age corresponding to 36 GWs were 100%, 62%, 51%, and 45%, respectively. Birth weight <600 g and gestational age <25 GWs were the independent risks for death and short-term disability. The primary risk factor for IVH grades II through IV was RDS. Low 5-minute Apgar scores predicted poor prognosis, ie, death or IVH, and antenatal steroid treatment to mothers with threatening premature labor seemed to protect infants against these. Some differences were found in the mortality rates between the 5 university hospital districts: neonatal mortality was significantly lower (25% vs 44%) in...

show abstract

Increased survival and deteriorating developmental outcome in 23 to 25 week old gestation infants, 1990-4 compared with 1984-9

Cited by 166 publications

References 12 publications

Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic

Risk factors associated with developmental abnormalities among high-risk children attended at a multidisciplinary clinic

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

A National Short-Term Follow-Up Study of Extremely Low Birth Weight Infants Born in Finland in 1996–1997

Contact Info

Product

Resources

About