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Comparative Study
. 2012 Dec 4:345:e7976.
doi: 10.1136/bmj.e7976.

Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies)

Kate L Costeloe  1 , Enid M Hennessy, Sadia Haider, Fiona Stacey, Neil Marlow, Elizabeth S Draper
Affiliations
Comparative Study

Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies)

Kate L Costeloe et al. BMJ. .

Abstract

Objective: To determine survival and neonatal morbidity for babies born between 22 and 26 weeks' gestation in England during 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks' gestation.

Design: Prospective national cohort studies.

Setting: Maternity and neonatal units in England.

Participants: 3133 births between 22 and 26 weeks' gestation in 2006; 666 admissions to neonatal units in 1995 and 1115 in 2006 of babies born between 22 and 25 weeks' gestation.

Main outcome measures: Survival to discharge from hospital, pregnancy and delivery outcomes, infant morbidity until discharge.

Results: In 2006, survival of live born babies was 2% (n=3) for those born at 22 weeks' gestation, 19% (n=66) at 23 weeks, 40% (n=178) at 24 weeks, 66% (n=346) at 25 weeks, and 77% (n=448) at 26 weeks (P<0.001). At discharge from hospital, 68% (n=705) of survivors had bronchopulmonary dysplasia (receiving supplemental oxygen at 36 weeks postmenstrual age), 13% (n=135) had evidence of serious abnormality on cerebral ultrasonography, and 16% (n=166) had laser treatment for retinopathy of prematurity. For babies born between 22 and 25 weeks' gestation from March to December, the number of admissions for neonatal care increased by 44%, from 666 in 1995 to 959 in 2006. By 2006 adherence to evidence based practice associated with improved outcome had significantly increased. Survival increased from 40% to 53% (P<0.001) overall and at each week of gestation: by 9.5% (confidence interval -0.1% to 19%) at 23 weeks, 12% (4% to 20%) at 24 weeks, and 16% (9% to 23%) at 25 weeks. The proportions of babies surviving in 2006 with bronchopulmonary dysplasia, major cerebral scan abnormality, or weight and/or head circumference <-2 SD were similar to those in 1995, but the proportion treated for retinopathy of prematurity had increased from 13% to 22% (P=0.006). Predictors of mortality and morbidity were similar in both cohorts.

Conclusion: Survival of babies born between 22 and 25 weeks' gestation has increased since 1995 but the pattern of major neonatal morbidity and the proportion of survivors affected are unchanged. These observations reflect an important increase in the number of preterm survivors at risk of later health problems.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years and no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Survival curves by gestational age (23-25 weeks) up to 120 days postnatal age for all babies admitted to neonatal intensive care and those surviving seven days. Each graph shows percentage (95% CI) change in survival to discharge
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Fig 2 Changes in important neonatal morbidities for babies born at 25 weeks’ gestation or less in 1995 and 2006 in England. Figures above bars show % change (95% confidence interval) from 1995 to 2006
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Fig 3 Changes in postnatal occipitofrontal circumference and weight z scores from birth to expected date of delivery (EDD) at discharge from hospital for babies born at 25 weeks of gestation or less in 1995 and 2006 in England. Figures above bars show SD change (95% confidence interval) from 1995 to 2006
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