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

Abstract

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.

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

“…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%.…”

“…[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%. 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%.…”

“…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.…”

“…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.…”

Decision-making in the delivery room: a survey of neonatologists

“…2 During an analogous time period in Belgium, similar marked increased survival by increasing gestational age was found. 3 Factors other than survival may influence medical support decisions at the extreme limits of viability. [4][5][6] By 2002, reports estimated a 30 to 50% chance of moderate to severe neurodevelopmental disability including blindness, deafness and cerebral palsy for infants born between 23 and 25 weeks, with many infants assessed at 18 to 30 months displaying more than one disability.…”