[Extreme prematurity: comparison of outcome at 5 years depending on gestational age below or above 26 weeks]

Abstract

Objective: Is it reasonable to care for children born under 26 gestational weeks (GW)? To answer this question, we compared outcome at 5 years of 2 groups of children:less or equal to 25 GW+6 days (group 1) and 26-27 GW+6 days (group 2).

Method: Retrospective study on extremely preterm children hospitalized in our center between 1999 and 2001. Perinatal data were obtained from medical reports. Five-year outcome was evaluated by questionnaire sent to Centers for Early Medicosocial Intervention, pediatricians or the child's parents. The children were classified according to their disability: none, minor or major. Progression was considered favorable if the child survived with or without minor disability and unfavorable if the child had died or had major disability.

Results: One hundred and sixty-six preterm babies were recorded. In group 1 (n=63), mortality was higher (58% vs 29%; p=0.0002), a neurologic cause was often responsible for death (36% vs 19%; p=0.018), a high level of intracranial hemorrhage was more frequent (35% vs 19%; p=0.002), and a decision to stop healthcare more often made (35% vs 18%; p=0.01) than in group 2 (n=103). Among the 99 survivors, 78 were being followed up at 5 years of age. In terms of disability, no difference was observed between group 1 (n=21) and group 2 (n=57). Including deaths, the risk for unfavorable progression was higher in group 1 (64% vs 41%; p=0.008).

Conclusion: The progression of under 26-GW preterm babies is more often unfavorable than the progression of babies born 26-27 GW+6 days. However, given the low number of patients, no significant difference was made concerning the prognosis at 5 years between the survivors of the 2 groups.