Survival and Long-Term Neurodevelopmental Outcome of Extremely Premature Infants Born at 23–26 Weeks’ Gestational Age at a Tertiary Center

Abstract

ABSTRACT. Objective. Long-term outcome, including school-age function, has been infrequently reported in infants born at ages as young as 23-26 weeks' gestation. The objective of this study is to report outcome on a large cohort of these infants to understand better the risks and factors that affect survival and long-term prognosis.Methods. Records from 1036 infants who were born between January 1, 1986, and December 31, 2000, were analyzed retrospectively by logistic regression to correlate multiple factors with both survival and long-term outcome. A total of 675 surviving infants were analyzed at a mean age of 47.5 months for developmental outcome. A subset of 147 surviving infants who were born before 1991 were followed through school-age years using the University of Vermont Achenbach Child Behavioral Checklist and Teachers Report Form. Longitudinal follow-up was performed comparing 1-year outcome with school-age performance.Results. Gestational age and recent year of birth correlated highly with survival. Maternal nonwhite race, female sex, inborn status, surfactant therapy, single gestation, and secondary sepsis also correlated positively with survival. Normal cranial ultrasound results, absence of chronic lung disease, female sex, cesarean delivery, and increased birth weight correlated favorably with long-term outcome. Infants who were born at 23 weeks were more likely to have severe impairments compared with those who were born at 24 -26 weeks. Early follow-up identified most subsequent physical impairments but correlated poorly with school-age function.Conclusions. Survival continues to improve for infants who are born at extremely early gestational ages, but long-term developmental concerns continue to be prevalent. Early outcomes do not reliably predict schoolage performance. Strategies that reduce severe intraventricular hemorrhage and chronic lung disease will likely yield the best chances to improve long-term outlook. Pediatrics 2004;113:e1-e6. URL: http://www.pediatrics. org/cgi/content/full/113/1/e1; prematurity, outcome, neurodevelopment, survival, follow-up.

Maternal and Perinatal Outcomes of Pregnancies Delivered at 23 Weeks’ Gestation

“…5,7,10,11,14,[16][17][18]20,36,37,47 Other studies include only infants admitted to the NICU, with survival rates ranging from 0% to 66%. 4,9,[11][12][13][14][15]17,18,20,21,23,24,34 Previous Canadian studies that did not include stillbirth noted survival rates in infants admitted to the NICU of 35.2% to 41.7%. 4,15,24 The survival rate was lower in our study.…”

“…Many of these studies, however, have excluded infants that were stillborn or that died before admission to NICU. 3,4,15,[21][22][23][24]27,34 In addition, some studies present data based on birth weight and not gestational age. 29,[40][41][42][43][44] Finally, a number of studies present data from populations that may differ from the Canadian population with respect to ethnicity and access to health care.…”

“…29,[40][41][42][43][44] Finally, a number of studies present data from populations that may differ from the Canadian population with respect to ethnicity and access to health care. 3,[7][8][9][10][11][12][13][14][16][17][18][19][20][21][22][23]34,45 Few studies have evaluated maternal outcomes of women delivering at a periviable gestation.…”

The smallest of the small: short-term outcomes of profoundly growth restricted and profoundly low birth weight preterm infants

“…6 Data on the effect of cesarean section of survival of preterm infants are contradictory. 14,15 However, data on 401 to 500 g infants suggests that those born by vaginal delivery are more likely to die in L&D and are less likely to survive to discharge. 2 These results are consistent with our study, where the effect of cesarean section on survival was most significant prior to NICU admission, less significant between NICU admission and 12 h of age and had no significant effect after 12 h of age.…”

Antenatal Counseling Regarding Resuscitation at an Extremely Low Gestational Age

“…[8][9][10][11][12][13][14][15][16][17][18] Estimated gestational age has served as the basis for estimating these risks for parents because of its strong association with outcome. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] However, there are limitations of using estimated gestational age alone for antenatal counseling purposes. One limitation is that the length of gestation is rarely certain to the precise day, except when conception occurred via in vitro fertilization.…”