ABSTRACT. Objective. Long-term outcome, including school-age function, has been infrequently reported in infants born at ages as young as 23-26 weeks' gestation. The objective of this study is to report outcome on a large cohort of these infants to understand better the risks and factors that affect survival and long-term prognosis.Methods. Records from 1036 infants who were born between January 1, 1986, and December 31, 2000, were analyzed retrospectively by logistic regression to correlate multiple factors with both survival and long-term outcome. A total of 675 surviving infants were analyzed at a mean age of 47.5 months for developmental outcome. A subset of 147 surviving infants who were born before 1991 were followed through school-age years using the University of Vermont Achenbach Child Behavioral Checklist and Teachers Report Form. Longitudinal follow-up was performed comparing 1-year outcome with school-age performance.Results. Gestational age and recent year of birth correlated highly with survival. Maternal nonwhite race, female sex, inborn status, surfactant therapy, single gestation, and secondary sepsis also correlated positively with survival. Normal cranial ultrasound results, absence of chronic lung disease, female sex, cesarean delivery, and increased birth weight correlated favorably with long-term outcome. Infants who were born at 23 weeks were more likely to have severe impairments compared with those who were born at 24 -26 weeks. Early follow-up identified most subsequent physical impairments but correlated poorly with school-age function.Conclusions. Survival continues to improve for infants who are born at extremely early gestational ages, but long-term developmental concerns continue to be prevalent. Early outcomes do not reliably predict schoolage performance. Strategies that reduce severe intraventricular hemorrhage and chronic lung disease will likely yield the best chances to improve long-term outlook. Pediatrics 2004;113:e1-e6. URL: http://www.pediatrics. org/cgi/content/full/113/1/e1; prematurity, outcome, neurodevelopment, survival, follow-up.

WHAT'S KNOWN ON THIS SUBJECT: Lung ultrasound outperforms conventional radiology in the emergency diagnosis of pneumothorax and pleural effusions. In the pediatric age, lung ultrasound has been also successfully applied to the fluid-to-air transition after birth and to rapid pneumonia diagnosis.

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W e read with interest the recent report by Haustein et al entitled "The likelihood of an indeterminate test result from a whole-blood interferon-␥ release assay for the diagnosis of Mycobacterium tuberculosis infection in children correlates with age and immune status." 1 This report adds to recent publications that question the performance of current interferon-␥ (IFN-␥) release assays (IGRA) for the diagnosis of tuberculosis (TB) in routine pediatric clinical practice. [2][3][4][5][6] The retrospective study by Haustein et al in 237 children highlights the high proportion of indeterminate test results ob-tained with the QuantiFERON-TB (QFT) Gold In-Tube assay (35% of the study population). Notably, indeterminate test results were over-represented in children younger than 5 years of age, and those with immunodeficiencies or medical conditions associated with immunosuppression. Importantly, these groups represent children most at risk for disease progression after exposure to M. tuberculosis. FIGURE 1.A, Relationship between PHA mitogen (positive) control response (censored at 15 IU/mL) and age with fitted linear regression line; (B) PHA mitogen control responses stratified by age (bars represent median values; P values were calculated by Mann-Whitney U test); (C) Proportion of indeterminate QFT assay results (ie, assays with failed PHA mitogen control response and/or high nil (negative) control combined) stratified by age ( 2 test).

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