Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec;6(1):e001619.
doi: 10.1136/bmjpo-2022-001619.

Survival and neurodevelopmental impairment of outborn preterm infants at 5.5 years of age: an EPIPAGE-2 prospective, matched study using multiple imputation

Peter Jones  1   2 , Laetitia Marchand-Martin  3 , Thomas Desplanches  3   4   5 , Caroline Diguisto  3   6 , Jeanne Fresson  3   7   8 , François Goffinet  3   9 , Stéphane Dauger  10 , Pierre-Yves Ancel  3   11 , Andrei Scott Morgan  12   13   14
Affiliations

Survival and neurodevelopmental impairment of outborn preterm infants at 5.5 years of age: an EPIPAGE-2 prospective, matched study using multiple imputation

Peter Jones et al. BMJ Paediatr Open. 2022 Dec.

Abstract

Objective: To determine whether birth outside a level-3 centre (outborn) is associated with a difference in the combined outcome of mortality or moderate-to-severe neurological impairment at 5.5 years of age compared with birth in a level-3 centre (inborn) when antenatal steroids and gestational age (GA) are accounted for.

Design: Individual matched study nested within a prospective cohort. Each outborn infant was matched using GA and antenatal steroids with a maximum of four inborns. Conditional logistic regression was used to calculate ORs before being adjusted using maternal and birth characteristics. Analyses were carried out after multiple imputation for missing data.

Setting: EPIPAGE-2 French national prospective cohort including births up to 34 weeks GA inclusive.

Patients: Outborn and inborn control infants selected between 24 and 31 weeks GA were followed in the neonatal period and to 2 and 5.5 years. 3335 infants were eligible of whom all 498 outborns and 1235 inborn infants were included-equivalent to 2.5 inborns for each outborn.

Main outcome measure: Survival without moderate-to-severe neurodevelopmental impairment at 5.5 years.

Results: Chorioamnionitis, pre-eclampsia, caesarian birth and small-for-dates were more frequent among inborns, and spontaneous labour and antepartum haemorrhage among outborns. There was no difference in the main outcome measure at 5.5 years of age (adjusted OR 1.09, 95% CI 0.82 to 1.44); sensitivity analyses suggested improved outcomes at lower GAs for inborns.

Conclusion: In this GA and steroid matched cohort, there was no difference in survival without moderate-to-severe neurodevelopmental impairment to 5.5 years of age between inborn and outborn very preterm children. This suggests steroids might be important in determining outcomes.

Keywords: Epidemiology; Mortality; Neonatology.

PubMed Disclaimer

Conflict of interest statement

Competing interests: Neil Marlow declares consultancy fees from Novartis and InfanDx GMBH during the past 5 years. There are no other competing interests.

Figures

Figure 1
Figure 1
Flow chart of children eligible for inclusion.
See this image and copyright information in PMC

References

    1. Lasswell SM, Barfield WD, Rochat RW, et al. . Perinatal regionalization for very low-birth-weight and very preterm infants: a meta-analysis. JAMA 2010;304:992–1000. 10.1001/jama.2010.1226 - DOI - PubMed
    1. Fang JL, Mara KC, Weaver AL, et al. . Outcomes of outborn extremely preterm neonates admitted to a NICU with respiratory distress. Arch Dis Child Fetal Neonatal Ed 2020;105:33–40. 10.1136/archdischild-2018-316244 - DOI - PubMed
    1. Mohamed MA, Aly H. Transport of premature infants is associated with increased risk for intraventricular haemorrhage. Arch Dis Child Fetal Neonatal Ed 2010;95:F403–7. 10.1136/adc.2010.183236 - DOI - PubMed
    1. Rautava L, Lehtonen L, Peltola M, et al. . The effect of birth in secondary- or tertiary-level hospitals in Finland on mortality in very preterm infants: a birth-register study. Pediatrics 2007;119:e257–63. 10.1542/peds.2006-1964 - DOI - PubMed
    1. Moro M, Figueras-Aloy J, Fernández C, et al. . Mortality for newborns of birthweight less than 1500 G in Spanish neonatal units (2002-2005). Am J Perinatol 2007;24:593–601. 10.1055/s-2007-992175 - DOI - PubMed

Publication types

LinkOut - more resources