Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994-9 compared with 2000-5

Field, David; Dorling, Jon; Manktelow, Bradley N; Draper, Elizabeth S

doi:10.1136/bmj.39555.670718.be

Cited by 197 publications

(149 citation statements)

References 17 publications

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“…In a prospective cohort study in a geographically defined population in the UK during 2000-2005, the survival rate to discharge of infants born at <25 + 6 wk was 47% (17). By contrast to previous studies, the majority (>90% of infants) were routinely exposed to antenatal steroids and postnatal surfactant.…”

Section: Sga and Respiratory Morbiditymentioning

confidence: 63%

Respiratory morbidity at follow-up of small-for-gestational-age infants born very prematurely

Peacock

D'Costa

et al. 2012

Pediatr Res

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Background:The aim of this study was to determine whether small-for-gestational-age (sGA) infants born very prematurely had increased respiratory morbidity in the neonatal period and at follow-up. Methods: Data were examined from infants recruited into the United Kingdom Oscillation study (UKOs). Of the 797 infants who were born at <29 wk of gestational age, 174 infants were sGA. Overall, 92% were exposed to antenatal corticosteroids and 97% received surfactant; follow-up data at 22-28 mo were available for 367 infants. results: After adjustment for gestational age and sex, sGA infants had higher rates of supplementary oxygen dependency at 36 wk postmenstrual age (odds ratio (OR): 3.23; 95% confidence interval: 2.03, 5.13), pulmonary hemorrhage (OR: 3.07; 95% cI: 1.82, 5.18), death (OR: 3.32; 95% cI: 2.13, 5.17), and postnatal corticosteroid requirement (OR: 2.09; 95% cI: 1.35, 3.23). After adjustment for infant and respiratory morbidity risk factors, a lower mean birth weight z-score was associated with a higher prevalence of respiratory admissions (OR: 1.40; 95% cI: 1.03, 1.88 for 1 sD change in z-score), cough (OR: 1.28; 95% cI: 1.00, 1.65), and use of chest medicines (OR: 1.32; 95% cI: 1.01, 1.73). conclusion: sGA infants who were born very prematurely, despite routine use of antenatal corticosteroids and postnatal surfactant, had increased respiratory morbidity at follow-up, which was not due to poor neonatal outcome.

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Section: Sga and Respiratory Morbiditymentioning

confidence: 63%

Respiratory morbidity at follow-up of small-for-gestational-age infants born very prematurely

Peacock

D'Costa

et al. 2012

Pediatr Res

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“…Previous studies have noted a wide range of survival rates for all births (including stillbirths) at this gestation, ranging from 0% to 37%. [5][6][7][9][10][11][12]14,[17][18][19]36,37 Some studies present survival rates for live births only, ranging from 0% to 53%. 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%.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Crane

Magee

Lee

et al. 2015

Journal of Obstetrics and Gynaecology Canada

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Objective: To evaluate the maternal and perinatal outcomes of pregnancies delivered at 23+0 to 23+6 weeks' gestation .Methods: This prospective cohort study included women in the Canadian Perinatal Network who were admitted to one of 16 Canadian tertiary perinatal units between August 1, 2005, and March 31, 2011, and who delivered at 23+0 to 23+6 weeks' gestation . Women were included in the network if they were admitted with spontaneous preterm labour with contractions, a short cervix without contractions, prolapsing membranes with membranes at or beyond the external os or a dilated cervix, preterm premature rupture of membranes, intrauterine growth restriction, gestational hypertension, or antepartum hemorrhage . Maternal outcomes included Caesarean section, placental abruption, and serious complication . Perinatal outcomes were mortality and serious morbidity .Results: A total of 248 women and 287 infants were included in the study . The rate of Caesarean section was 10 .5% (26/248) and 40 .3% of women (100/248) had a serious complication, the most common being chorioamnionitis (38 .6%), followed by blood transfusion (4 .5% (25/25) . Two subgroup analyses were performed: in one, antepartum stillbirths were excluded, and in the other only centres that indicated they offered fetal monitoring at 23 weeks' gestation were included and antepartum stillbirths were excluded . In each of these, perinatal outcomes similar to the overall group were found . Conclusion:Pregnant women delivering at 23 weeks' gestation are at risk of morbidity . Their infants have high rates of serious morbidity and mortality . Further research is needed to identify strategies and forms of management that not only increase perinatal survival but also reduce morbidities in these extremely low gestational age infants and reduce maternal morbidity .

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“…A dvances in neonatal care over the past few decades have resulted in increasing survival of babies born less than 25 completed weeks of gestation (extremely pre-term (EP)) [1]. Nevertheless, the prevalence of bronchopulmonary dysplasia (BPD), remains high in such infants [2], and our understanding of the implications of EP birth and any subsequent lung injury on lifelong lung function (LF) remains limited.…”

mentioning

confidence: 99%

Nature and severity of lung function abnormalities in extremely pre-term children at 11 years of age

Lum¹,

Kirkby²,

Welsh³

et al. 2010

Eur Respir J

156

140

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Advances in neonatal care have resulted in increased survival of children born extremely pre-term (EP). Nevertheless the incidence of bronchopulmonary dysplasia and longterm respiratory morbidity remains high. We investigated the nature of pathophysiological changes at 11 yrs of age to ascertain whether respiratory morbidity in EP children primarily reflects alterations in the lung periphery or more centralised airway function in this population.Spirometry, plethysmography, diffusing capacity, exhaled nitric oxide, multiple-breath washout, skin tests and methacholine challenge were used during laboratory-based assessments in a subgroup of the 1995 EPICure cohort and in controls.Results were obtained in 49 EP and 52 control children. Lung function abnormalities were found in 78% of EP children, with evidence of airway obstruction, ventilation inhomogeneity, gas trapping and airway hyperresponsiveness. Levels of atopy and exhaled nitric oxide were similar between the groups. Prior wheeze was associated with significant reductions in forced flows and volumes. By contrast, abnormalities of the lung periphery appear to be mediated primarily through EP birth per se.The prevalence of lung function abnormalities, which is largely obstructive in nature and likely to have long-term implications, remains high among 11-yr-old children born EP. Spirometry proved an effective means of detecting these persistent abnormalities.

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Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994-9 compared with 2000-5

Cited by 197 publications

References 17 publications

Respiratory morbidity at follow-up of small-for-gestational-age infants born very prematurely

Respiratory morbidity at follow-up of small-for-gestational-age infants born very prematurely

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

Nature and severity of lung function abnormalities in extremely pre-term children at 11 years of age

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