Outcome of infants born at 24–26 weeks' gestation: I. survival and cost

Kilpatrick, Sarah J.; Schlueter, Mureen A.; Piecuch, Robert E.; Leonard, Carol H.; Rogido, M.; Sola, Augusto

doi:10.1016/s0029-7844(97)00483-3

Cited by 90 publications

(45 citation statements)

References 18 publications

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“…42 From the data on survival and neonatal morbidity of this and other cohort studies of EPT fetuses and infants, for the time being, it can be concluded that if prolongation is unsuccessful, then outcome perspectives should be discussed and treatment options including nonintervention explicitly be made available to parents of infants of Ͻ26 weeks' gestation within the limits of medical feasibility and appropriateness. 43,44 However, as there seems to be a continuing trend toward improved outcomes, longitudinal studies will remain important for monitoring continuing changes in EPT outcomes. 11…”

Section: Figmentioning

confidence: 99%

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

Vanhaesebrouck

Allegaert²,

Bottu³

et al. 2004

Pediatrics

182

123

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ABSTRACT. Objective. To determine mortality and morbidity at discharge from the hospital of a large population-based cohort of infants who were born at <26 weeks' gestation.Methods. Perinatal data were collected on extremely preterm infants who were alive at the onset of labor and born between January 1, 1999, and December 31, 2000, in all 19 Belgian perinatal centers.Results. A total of 525 infants were recorded. Lifesupporting care was provided to 322 liveborn infants, 303 of whom were admitted for intensive care. The overall survival rate of liveborn infants was 54%. Of the infants who were alive at the age of 7 days, 82% survived to discharge. Vaginal delivery, shorter gestation, air leak, longer ventilator dependence, and higher initial oxygen need all were independently associated with death; gender, plurality, and surfactant therapy were not. Among the 175 survivors, 63% had 1 or more of the 3 major adverse outcome variables at the time of discharge (serious neuromorbidity, chronic lung disease at 36 weeks' postmenstrual age, or treated retinopathy of prematurity). The chance of survival free from serious neonatal morbidity at the time of hospital discharge was <15% (21 of 158) for the admitted infants with a gestation <26 weeks.Conclusions. If for the time being prolongation of pregnancy is unsuccessful, then outcome perspectives should be discussed and treatment options including nonintervention explicitly be made available to parents of infants of <26 weeks' gestation within the limits of medical feasibility and appropriateness. Pediatrics 2004; 114:663-675; extreme prematurity, mortality, morbidity, population-based cohort.

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Section: Figmentioning

confidence: 99%

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

Vanhaesebrouck

Allegaert²,

Bottu³

et al. 2004

Pediatrics

182

123

View full text Add to dashboard Cite

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“…Cognitive developmental disability at 2 1/2 years occurred in approximately 1 in 4 survivors. Survival without chronic lung disease or severe retinopathy of prematurity increased from 35% at 24 weeks to 78% at 26 weeks [Kilpatrick et al, 1997]. Parenchymal brain injury (severe intraventricular hemorrhage or cystic periventricular leukomalaica) occurred in 11% of those born at 24 weeks, 23% in those born at 25 weeks, and 8.9% in those born at 26 weeks and predicted neuromotor outcome [Piecuch et al, 1997a].…”

Section: Early Childhood Developmental Competencies At Ages 18 Monthsmentioning

confidence: 99%

Measuring functional outcomes after prematurity: Developmental impact of very low birth weight and extremely low birth weight status on childhood disability

Msall

Tremont

2002

Ment. Retard. Dev. Disabil. Res. Rev.

111

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Our purpose was to describe functional outcomes in essential activities in preschool, school-age, and adolescent children who were born very (<32 weeks gestation) and extremely (<28 weeks gestation) prematurely. Very low birth weight (VLBW; 1000-1499 g), or extremely low birth weight (ELBW;<1000 g) populations are the focus of our analysis. We describe models of disablement and enablement for specifying the complexity of childhood outcomes using a framework of pathophysiology, impairment, functional limitation and functional strengths, disability in social roles and social participation, societal limitations and environmental facilitators. Representative early childhood, preschool, school-age, and adolescent studies were examined in terms of describing children's functional strengths and challenges after VLBW and ELBW survival. In early childhood, disability was assessed by diagnosing neurosensory impairments and delays on developmental testing. Instruments for measuring functional status in essential activities of self-care, mobility, communication and learning are described. Rates of neurosensory disability in the first three years among recent ELBW survivors ranged from 9-26% for cerebral palsy, 1-15% for blindness, 0-9% for deafness, and 6-42% for evolving cognitive disability (MDI <70). Rates of preschool functional limitation were 5-27% motor, 5-30% self-care, and 5-22% communicative. Rates of school-age functional educational disabilities exceeded 50%. Rates of adolescent activity limitation were 13-32% and vocational limitations were 27-71%. By examining the functional strengths and challenges of children with major neurodevelopmental impairments after very or extremely preterm birth, we can examine causal pathways that lessen the risk of severe functional disability. Among children with mild to moderate disability, we can enhance functional outcomes, optimize community participation, and provide quality family supports. In order to assess the changing outcomes of this vulnerable population of survivors, combinations of clinical and survey based methodologies are required.

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“…Most outcome reports contain relatively few patients. [1][2][3][4] Survival statistics vary and do not always account for the aggressiveness of support, which can also vary between centers. Longterm outcome information seems unfavorable compared with more mature preterm infants, 5,6 but intact survival with normal cognitive function has been reported.…”

mentioning

confidence: 99%

Survival and Long-Term Neurodevelopmental Outcome of Extremely Premature Infants Born at 23–26 Weeks’ Gestational Age at a Tertiary Center

Hoekstra¹,

Ferrara²,

Couser³

et al. 2004

Pediatrics

176

134

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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.

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Outcome of infants born at 24–26 weeks' gestation: I. survival and cost

Cited by 90 publications

References 18 publications

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

Measuring functional outcomes after prematurity: Developmental impact of very low birth weight and extremely low birth weight status on childhood disability

Survival and Long-Term Neurodevelopmental Outcome of Extremely Premature Infants Born at 23–26 Weeks’ Gestational Age at a Tertiary Center

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