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Changes in neurodevelopmental outcome at age eight in geographic cohorts of children born at 22–27 weeks' gestational age during the 1990s

Abstract

Background The survival rate for children born with gestational ages 22–27 weeks is increasing, and this may be associated with higher rates of disability. The aims of this study were to determine the outcomes at age eight for a regional cohort of children born at 22–27 weeks during 1997, and to compare their rates of disability with a cohort of the same gestational age born in 1991–1992.

Methods Consecutive children with gestational ages in the range 22–27 weeks born in the state of Victoria, Australia, in 1997 and matched term controls were assessed at 8 years. Outcomes included blindness, deafness, cerebral palsy (CP) and intellectual impairment and disabilities caused by these impairments. These outcomes were compared with a cohort of 22–27-week and term children born in 1991–1992 in the same region.

Results Follow-up rates for the 1997 cohort at 8 years of age were 95% (144/151) for 22–27 weeks survivors and 89% (173/195) for controls. Rates of disability were substantially higher in the preterm cohort than the controls. The 1997 and 1991–1992 preterm cohorts had similar rates of moderate or severe disability (19%), however the rate of mild impairment was greater in 1997 (40% vs 24%). Rates of disability were almost identical in control groups. Intellectual impairment and CP were the major reasons for the higher rates of disability.

Conclusions The high prevalence of adverse neurodevelopmental outcome in children born at 22–27 weeks compared with term controls at school age persists, and may even be increasing over time.

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