Predicting neurosensory disabilities at two years of age in a national cohort of extremely premature infants
Introduction
During the last decades, survival rates among extremely premature infants have increased due to the use of antenatal steroids and surfactant, as well as advances in medical technology and knowledge [1]. Still, the number of children surviving with disabilities remains high, [2] and may even have increased [3], [4]. Therefore, with the advances in care, studies on the outcome are needed in order to identify early clinical characteristics, therapeutic measures and results of diagnostic tests which may be important prognostic factors. In particular, it is important to study the results of providing life support to immature infants at the limit of viability. The lower gestational age (GA) limit for offering life support is a matter of ongoing debate, and recommendations vary from 23 to 26 weeks [5], [6].
Neonatologists are challenged with stating prognosis at particularly two stages in the care of premature infants. First, before birth, prediction of survival without substantial sequelae is based on GA, estimated birth weight (BW) and clinical characteristics during pregnancy. We have previously shown that in extremely preterm infants, GA is the dominating predictor of neonatal mortality and morbidity [7]. Next, at discharge from the neonatal intensive care unit (NICU), a developmental prognosis is requested on the basis of the same factors and data obtained from the NICU course. Therefore, accurate evidence based knowledge on the significance of such factors is of paramount importance when deciding on guidelines for management and follow-up, and for advising families. A rational approach to advice on infants born at the threshold of viability is to compare their outcomes with those of infants born less preterm and for whom it is not controversial to offer life support, e.g. infants born at 26 weeks' GA or later.
The aim of the present study was to assess the predictive value of pre-, peri-, and postnatal clinical characteristics and the results of diagnostic examinations performed in the NICU in relation to specific neurosensory disabilities at 2 years of age in children born extremely premature.
Section snippets
Patients
Data were prospectively collected for all births of infants with GA 220 to 276 weeks or BW 500 to 999 g born in Norway during 1999 and 2000. Data on outcomes until death or discharged home from the NICU have previously been published [7], [8], [9], [10]. Of 638 births, 153 (24%) were stillborn and 21 (3%) died in the delivery room, 15 of them without attempted resuscitation. Outcome was unknown for two infants. Of the remaining 462, 376 (59%) were discharged home alive, i.e. 81% of the admitted
Results
Of the 376 infants discharged from the NICU, three died. Two infants without major morbidity in the NICU died of sudden infant death syndrome, and one from a congenital syndrome. Of the 373 survivors, 343 (92%) met for the follow-up examination at a mean (SD) corrected age of 24 (3) months. For the remaining 30 (8%) children, data were derived from routine medical follow-up records and telephone interviews.
Background data of the survivors are given in Table 1. For the infants treated with
Discussion
In this national cohort of extremely preterm infants, we have previously shown that GA was the dominating predictor of neonatal mortality and morbidity, and that BW and some perinatal factors were of minor significance [7]. The present study showed that at 2 years corrected age, major neurosensory disability was significantly associated with major CUS pathology, ROP and prolonged use of postnatal steroids for treatment of lung disease. Chorioamnionitis may have represented a minor but
No authors have disclosed conflict of interests.
Acknowledgements
The study was funded by the Norwegian Foundation for Health and Rehabilitation through The Unexpected Child Death Society of Norway, the Research Council of Norway and Helse Vest Hospital Trust.
For technical assistance: Inger Elise Engelund and Magnhild Viste, Medical Birth Registry of Norway, Locus of Registry-based Epidemiology.
Other members of the Norwegian Extreme Prematurity Study were as follows:
Pediatrics: Inger E. Silberg and Sven Harald Andersen, Østfold Hospital, Fredrikstad; Jørgen
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