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. 2022 Sep;107(5):467-474.
doi: 10.1136/archdischild-2021-323124. Epub 2022 Mar 2.

Two-year neurodevelopmental outcome in children born extremely preterm: the EPI-DAF study

Pauline E van Beek  1 , Monique Rijken  2 , Lisa Broeders  3 , Hendrik J Ter Horst  4 , Corine Koopman-Esseboom  5 , Ellen de Kort  6 , Céleste Laarman  7 , Susanne M Mulder-de Tollenaer  8 , Katerina Steiner  9 , Renate Mc Swarte  10 , Elke van Westering-Kroon  11 , S Guid Oei  12   13 , Aleid G Leemhuis  14 , Peter Andriessen  15   16 ; EPI-DAF study group
Collaborators, Affiliations

Two-year neurodevelopmental outcome in children born extremely preterm: the EPI-DAF study

Pauline E van Beek et al. Arch Dis Child Fetal Neonatal Ed. 2022 Sep.

Abstract

Objective: In 2010, the Dutch practice regarding initiation of active treatment in extremely preterm infants was lowered from 25 completed weeks' to 24 completed weeks' gestation. The nationwide Extremely Preterm Infants - Dutch Analysis on Follow-up Study was set up to provide up-to-date data on neurodevelopmental outcome at 2 years' corrected age (CA) after this guideline change. Design: National cohort study.

Patients: All live born infants between 240/7 weeks' and 266/7 weeks' gestational age who were 2 years' CA in 2018-2020.

Main outcome measure: Impairment at 2 years' CA, based on cognitive score (Bayley-III-NL), neurological examination and neurosensory function.

Results: 651 of 991 live born infants (66%) survived to 2 years' CA, with data available for 554 (85%). Overall, 62% had no impairment, 29% mild impairment and 9% moderate-to-severe impairment (further defined as neurodevelopmental impairment, NDI). The percentage of survivors with NDI was comparable for infants born at 24 weeks', 25 weeks' and 26 weeks' gestation. After multivariable analysis, severe brain injury and low maternal education were associated with higher odds on NDI. NDI-free survival was 48%, 67% and 75% in neonatal intensive care unit (NICU)-admitted infants at 24, 25 and 26 weeks' gestation, respectively.

Conclusions: Lowering the threshold has not been accompanied by a large increase in moderate-to-severely impaired infants. Among live-born and NICU-admitted infants, an increase in NDI-free survival was observed from 24 weeks' to 26 weeks' gestation. This description of a national cohort with high follow-up rates gives an accurate description of the range of outcomes that may occur after extremely preterm birth.

Keywords: child health; epidemiology; infant development; intensive care units; neonatal; neonatology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Imputed overall neurodevelopmental outcome, classified as no, mild or moderate-to-severe impairment (ie, NDI), using defined categories of cognitive development, neurological examination and neurosensory function for different GA groups, using all live-born infants as the denominator. (B) Imputed overall neurodevelopmental outcome, classified as no, mild or moderate-to-severe impairment (ie, NDI), using defined categories of cognitive development, neurological examination and neurosensory function, using all NICU-admitted infants as the denominator. GA, gestational age; NDI, neurodevelopmental impairment; NICU, neonatal intensive care unit. Figures might not add up to 100% due to rounding.
See this image and copyright information in PMC

References

    1. Stoll BJ, Hansen NI, Bell EF, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA 2015;314:1039–51. 10.1001/jama.2015.10244 - DOI - PMC - PubMed
    1. Patel RM, Kandefer S, Walsh MC, et al. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med 2015;372:331–40. 10.1056/NEJMoa1403489 - DOI - PMC - PubMed
    1. Linsell L, Johnson S, Wolke D, et al. Trajectories of behavior, attention, social and emotional problems from childhood to early adulthood following extremely preterm birth: a prospective cohort study. Eur Child Adolesc Psychiatry 2019;28:531–42. 10.1007/s00787-018-1219-8 - DOI - PMC - PubMed
    1. Torchin H, Morgan AS, Ancel P-Y. International comparisons of neurodevelopmental outcomes in infants born very preterm. Semin Fetal Neonatal Med 2020;25:101109. 10.1016/j.siny.2020.101109 - DOI - PubMed
    1. Marlow N, Wolke D, Bracewell MA, et al. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 2005;352:9–19. 10.1056/NEJMoa041367 - DOI - PubMed