You are here

  • Home
  • Archive
  • Volume 109, Issue 5
  • Neurosensory, cognitive and academic outcomes at 8 years in children born 22–23 weeks’ gestation compared with more mature births

Article Text

Article menu
Download PDFPDF
Original research
Neurosensory, cognitive and academic outcomes at 8 years in children born 22–23 weeks’ gestation compared with more mature births
  1. India RM Marks1,
  2. Lex W Doyle1,2,3,4,
  3. Rheanna M Mainzer4,5,
  4. Alicia J Spittle1,6,
  5. Marissa Clark7,
  6. Rosemarie A Boland1,3,
  7. Peter J Anderson1,8,
  8. Jeanie LY Cheong1,2,3,4
  1. 1 Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  2. 2 Newborn Research, Royal Women's Hospital, Melbourne, Victoria, Australia
  3. 3 Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
  4. 4 Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
  5. 5 Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  6. 6 Department of Physiotherapy, University of Melbourne, Parkville, Victoria, Australia
  7. 7 Department of Neonatology, Monash Medical Centre, Clayton, Victoria, Australia
  8. 8 Turner Institute for Brain and Mental Health & School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Professor Jeanie LY Cheong; jeanie.cheong{at}thewomens.org.au

Abstract

Despite providing intensive care to more infants born <24 weeks’ gestation, data on school-age outcomes, critical for counselling and decision-making, are sparse.

Objective To compare major neurosensory, cognitive and academic impairment among school-aged children born extremely preterm at 22–23 weeks’ gestation (EP22–23) with those born 24–25 weeks (EP24–25), 26–27 weeks (EP26–27) and term (≥37 weeks).

Design Three prospective longitudinal cohorts.

Setting Victoria, Australia.

Participants All EP live births (22–27 weeks) and term-born controls born in 1991–1992, 1997 and 2005.

Main outcome measures At 8 years, major neurosensory disability (any of moderate/severe cerebral palsy, IQ <−2 SD relative to controls, blindness or deafness), motor, cognitive and academic impairment, executive dysfunction and poor health utility. Risk ratios (RRs) and risk differences between EP22–23 (reference) and other gestational age groups were estimated using generalised linear models, adjusted for era of birth, social risk and multiple birth.

Results The risk of major neurosensory disability was higher for EP22–23 (n=21) than more mature groups (168 EP24–25; 312 EP26–27; 576 term), with increasing magnitude of difference as the gestation increased (adjusted RR (95% CI) compared with EP24–25: 1.39 (0.70 to 2.76), p=0.35; EP26–27: 1.85 (0.95 to 3.61), p=0.07; term: 13.9 (5.75 to 33.7), p<0.001). Similar trends were seen with other outcomes. Two-thirds of EP22–23 survivors were free of major neurosensory disability.

Conclusions Although children born EP22–23 experienced higher rates of disability and impairment at 8 years than children born more maturely, many were free of major neurosensory disability. These data support providing active care to infants born EP22–23.

  • Neonatology
  • Child Health
  • Intensive Care Units, Neonatal

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/archdischild-2023-326277

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon reasonable request.

    View Full Text

    Footnotes

    • X @roseandtoby

    • Contributors All listed authors have made substantial contributions to this work within various areas of the research process: JLYC and LWD—conception and design of the study, data analysis and interpretation, drafting and revising the work and approval of the final manuscript as submitted. IM, AS and PA—conception and design of the study, data interpretation, drafting and revising the work and approval of the final manuscript as submitted. RM—data analysis and interpretation, drafting and revising the work and approval of the final manuscript as submitted. MC and RAB—data interpretation, drafting and revising the work and approval of the final manuscript as submitted. All authors are accountable for the work.

    • Funding Supported by grants from the National Health and Medical Research Council of Australia (Centre of Clinical Research Excellence) #546519; Centre of Research Excellence #1060733 & #1153176; Project Grant #108702; Leadership Level 1 #2016390 to JC, and #1176077 to PJA), and the Victorian Government’s Operational Infrastructure Support Program. The funding sources had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.