Neurodevelopmental Outcome in Extremely Preterm Infants at 2.5 Years After Active Perinatal Care in Sweden

Abstract

PROACTIVE APPROACH TO resuscitation and intensive care of extremely preterm infants (Ͻ27 gestational weeks) has increased survival and lowered the gestational age of viability. 1-4 There are concerns that increased survival may come at the cost of later neurodevelopmental disability among survivors. Approximately 25% of extremely preterm infants born in the 1990s had a major disability at preschool age, such as impaired mental development, cerebral palsy (CP), blindness, or deafness. 5,6 More recent studies report decreasing, 7,8 unchanged, 2 or increasing rates of neurodevelopmental disability 9-11 at preschool age compared with previous decades. The most immature infants, ie, those born before 25 weeks Author Affiliations and Members of the EXPRESS Group appear at the end of this article.

The Preterm Heart in Childhood: Left Ventricular Structure, Geometry, and Function Assessed by Echocardiography in 6‐Year‐Old Survivors of Periviable Births

“…The higher LVM in adults could be attributed to higher blood pressures in adults who were born preterm than in those born at term,4 whereas blood pressure differences in our cohort were small or nonexistent. Infants,19 children,7 and adolescents8 born preterm have—as in our cohort—been found to exhibit similar or even lower LVM than peers born at term, also in the presence of elevated blood pressure 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20…”

“…Inclusion and exclusion criteria, perinatal characteristics, and data on survival, neonatal morbidity, neurodevelopmental outcomes at 30 months and 6.5 years of age, and vascular outcomes in childhood have been reported previously 9, 10, 11, 12, 13…”

Lung function after extremely preterm birth—A population‐based cohort study (EXPRESS)

“…have previously been reported. 1,4,6 All EXPRESS-children in three out of the seven Swedish health care regions (n = 250, 51% of the total cohort) were invited to a followup study on lung function at 6½-years-of-age (±3 months). Exclusion criteria were congenital cardiovascular or pulmonary malformations.…”

Recombinant human erythropoietin improves neurological outcomes in very preterm infants

“…1 However, very preterm infants have a high risk of severe short‐term complications such as intracranial hemorrhage (ICH), periventricular leukomalacia (PVL), retinopathy of prematurity (ROP), and long‐term neurodevelopmental disorders such as cerebral palsy, intellectual disabilities, and hearing and vision impairment,2, 3 and prematurity is still a leading cause of neonatal death. Although active perinatal care has improved neurodevelopmental outcomes in extremely preterm infants, the most extremely preterm infants continue to have high rates of neurological disabilities 3, 4. These neurological disabilities are still a significant burden on families and society, and the current therapy for preterm brain injury is mainly supportive and seeks to maintain physiological parameters.…”