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Canadian developmental outcomes <29 weeks
The Canadian Neonatal Network (Synnes et al) reports the outcome of a large (3 700) cohort of babies born <29 weeks, together with the principal factors associated with neurodevelopmental impairment. Several things emerged that are of interest. Although statistically highly significant, the effect of gestational age per se was smaller, in almost every analysis, than any other factor except administration of antenatal steroids. The effect of GA was largely mediated by the usual suspects such as necrotising enterocolitis and brain injury, and the disadvantage attributable to male sex was greater than the advantages of either higher gestational age or antenatal steroids. The most striking finding was the effect of place of treatment: although the authors don't allude to it until their very last sentence, the variation in outcomes by site of care is clearly the elephant in the room. See page F235.
Developmental outcome and oesophageal atresia
Other than in congenital heart disease, there has been relatively little attention given to the long term developmental outcomes of congenital anomalies needing early surgical correction. But as with congenital heart disease, there is the constant difficulty of …