Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies)

Objective To determine survival and neonatal morbidity for babies born between 22 and 26 weeks’ gestation in England during 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks’ gestation. Design Prospective national cohort studies. Setting Maternity and neonatal units in England. Participants 3133 births between 22 and 26 weeks’ gestation in 2006; 666 admissions to neonatal units in 1995 and 1115 in 2006 of babies born between 22 and 25 weeks’ gestation. Main outcome measures Survival to discharge from hospital, pregnancy and delivery outcomes, infant morbidity until discharge. Results In 2006, survival of live born babies was 2% (n=3) for those born at 22 weeks’ gestation, 19% (n=66) at 23 weeks, 40% (n=178) at 24 weeks, 66% (n=346) at 25 weeks, and 77% (n=448) at 26 weeks (P<0.001). At discharge from hospital, 68% (n=705) of survivors had bronchopulmonary dysplasia (receiving supplemental oxygen at 36 weeks postmenstrual age), 13% (n=135) had evidence of serious abnormality on cerebral ultrasonography, and 16% (n=166) had laser treatment for retinopathy of prematurity. For babies born between 22 and 25 weeks’ gestation from March to December, the number of admissions for neonatal care increased by 44%, from 666 in 1995 to 959 in 2006. By 2006 adherence to evidence based practice associated with improved outcome had significantly increased. Survival increased from 40% to 53% (P<0.001) overall and at each week of gestation: by 9.5% (confidence interval −0.1% to 19%) at 23 weeks, 12% (4% to 20%) at 24 weeks, and 16% (9% to 23%) at 25 weeks. The proportions of babies surviving in 2006 with bronchopulmonary dysplasia, major cerebral scan abnormality, or weight and/or head circumference <−2 SD were similar to those in 1995, but the proportion treated for retinopathy of prematurity had increased from 13% to 22% (P=0.006). Predictors of mortality and morbidity were similar in both cohorts. Conclusion Survival of babies born between 22 and 25 weeks’ gestation has increased since 1995 but the pattern of major neonatal morbidity and the proportion of survivors affected are unchanged. These observations reflect an important increase in the number of preterm survivors at risk of later health problems.

[1]  K. Costeloe,et al.  An investigation into the reporting and management of late terminations of pregnancy (between 22+0 and 26+6 weeks of gestation) within NHS Hospitals in England in 2006: the EPICure preterm cohort study , 2012, BJOG : an international journal of obstetrics and gynaecology.

[2]  N. Modi,et al.  National neonatal data to support specialist care and improve infant outcomes , 2012, Archives of Disease in Childhood: Fetal and Neonatal Edition.

[3]  W. Göpel,et al.  Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial , 2011, The Lancet.

[4]  Neil Marlow,et al.  Lung Function and Respiratory Symptoms at 11 Years in Children Born Extremely Preterm: The Epicure Study , 2011, Pediatrics.

[5]  J. Stocks,et al.  Cardiovascular consequences of extreme prematurity: the EPICure study , 2011, Journal of hypertension.

[6]  J. Neu,et al.  The intestinal microbiome of infants and the use of probiotics , 2011, Current opinion in pediatrics.

[7]  L. Doyle,et al.  Changing long-term outcomes for infants 500–999 g birth weight in Victoria, 1979–2005 , 2011, Archives of Disease in Childhood: Fetal and Neonatal Edition.

[8]  L. Saiman,et al.  Statewide NICU Central-Line-Associated Bloodstream Infection Rates Decline After Bundles and Checklists , 2011, Pediatrics.

[9]  N. Marlow,et al.  Educational Outcomes in Extremely Preterm Children: Neuropsychological Correlates and Predictors of Attainment , 2011, Developmental neuropsychology.

[10]  B. Vohr,et al.  Early-Childhood Neurodevelopmental Outcomes Are Not Improving for Infants Born at <25 Weeks' Gestational Age , 2011, Pediatrics.

[11]  K. Watterberg.  Postnatal Corticosteroids to Prevent or Treat Bronchopulmonary Dysplasia , 2010, Pediatrics.

[12]  H. Leitich,et al.  Is it Possible to Make a Reliable Prognosis within the First Hour of Life for Very Low Birth Weight Infants Delivered after Preterm Premature Rupture of Membranes? , 2010, Neonatology.

[13]  M. Kaminski,et al.  Predictors of cerebral palsy in very preterm infants: the EPIPAGE prospective population‐based cohort study , 2010, Developmental medicine and child neurology.

[14]  Abhik Das,et al.  Early CPAP versus surfactant in extremely preterm infants. , 2010, The New England journal of medicine.

[15]  N. Marlow,et al.  Autism spectrum disorders in extremely preterm children. , 2010, The Journal of pediatrics.

[16]  S. Vohra,et al.  Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. , 2010, The Cochrane database of systematic reviews.

[17]  N. Marlow,et al.  Neurodevelopmental Disability Through 11 Years of Age in Children Born Before 26 Weeks of Gestation , 2009, Pediatrics.

[18]  Hugo Lagercrantz,et al.  One-year survival of extremely preterm infants after active perinatal care in Sweden. , 2009, JAMA.

[19]  Neil Marlow,et al.  Long-term impact of neonatal intensive care and surgery on somatosensory perception in children born extremely preterm , 2009, PAIN®.

[20]  E. Draper,et al.  Rates of very preterm birth in Europe and neonatal mortality rates , 2008, Archives of Disease in Childhood Fetal and Neonatal Edition.

[21]  Bradley N Manktelow,et al.  Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994-9 compared with 2000-5 , 2008, BMJ : British Medical Journal.

[22]  J. Carlin,et al.  Nasal CPAP or intubation at birth for very preterm infants. , 2008, The New England journal of medicine.

[23]  Saroj Saigal,et al.  An overview of mortality and sequelae of preterm birth from infancy to adulthood , 2008, The Lancet.

[24]  Julie Brown,et al.  Antenatal Corticosteroids for Accelerating Fetal Lung Maturation for Women at Risk of Preterm Birth , 2007, The Cochrane database of systematic reviews.

[25]  Neil Marlow,et al.  Establishing neonatal networks: the reality , 2006, Archives of Disease in Childhood - Fetal and Neonatal Edition.

[26]  Michael C. Wendl,et al.  Argonaute—a database for gene regulation by mammalian microRNAs , 2005, BMC Bioinformatics.

[27]  R. Soll,et al.  Overview of Surfactant Replacement Trials , 2005, Journal of Perinatology.

[28]  N Marlow,et al.  The EPICure study: associations and antecedents of neurological and developmental disability at 30 months of age following extremely preterm birth , 2005, Archives of Disease in Childhood - Fetal and Neonatal Edition.

[29]  S. Håkansson,et al.  Proactive management promotes outcome in extremely preterm infants: a population-based comparison of two perinatal management strategies. , 2004, Pediatrics.

[30]  N Marlow,et al.  Neurocognitive outcome after very preterm birth , 2004, Archives of Disease in Childhood - Fetal and Neonatal Edition.

[31]  Neil Marlow,et al.  The EPICure Study: Outcomes to Discharge From Hospital for Infants Born at the Threshold of Viability , 2000, Pediatrics.

[32]  J. Horbar.  The Vermont Oxford Network: evidence-based quality improvement for neonatology. , 1999, Pediatrics.

[33]  P. Davis,et al.  Managing oxygen therapy during delivery room stabilization of preterm infants. , 2012, The Journal of pediatrics.

[34]  J. Stockman.  One-Year Survival of Extremely Preterm Infants After Active Perinatal Care in Sweden , 2011 .

[35]  Clinical Excellence.  Antenatal care : routine care for the healthy pregnant woman , 2008 .

[36]  P. P. Berg.  Proactive Management Promotes Outcome in Extremely Preterm Infants: A Population-Based Comparison of Two Perinatal Management Strategies , 2006 .

[37]  Anna L. Ells,et al.  The International Classification of Retinopathy of Prematurity revisited. , 2005, Archives of ophthalmology.