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Outcomes at 20-25 Weeks Gestation
Neurologic and Developmental Disability after Extremely Preterm Birth. Wood NS, Marlow N, Costeloe K, et al. New Engl J Med 2000; 343: 378-84.
This study evaluated all children who were born at 25 or fewer weeks gestation in the United Kingdom and Ireland from March through December 1995 at the time when they reached a median age of 30 months. Development was evaluated using Bayley Scales of Infant Development, and neurologic function was assessed by a standardized examination. 283 (92%) of 308 surviving children were formally assessed. The mean (+/- SD) scores on the Bayley Motor and Psychomotor developmental indices were 84 +/- 12 and 87 +/- 13 respectively. 19% had severely delayed development (>3 SD below the mean) and a further 11% had scores between 2-3 SD below the mean. 10% had severe neuromotor disability, 2% were blind or perceived light only, and 3% had significant hearing loss. Overall, 49% had disability (including 23% with severe disability), and 49% had no disability.
Comment. This study was done by the EPICure Study Group who prospectively looked at outcomes of extremely premature infants born at 276 maternity units in the United Kingdom and Ireland. The data showed that 79% of infants born at 20-25 weeks died before admission to a NICU, 12% died before discharge, and 8% survived (with <1% dying after discharge but before 2 ½ years of age. Among the survivors at 2 ½ years of age, roughly half had no disability, ¼ had severe disability, and ¼ had less-than-severe disability. The strength of this study is that the cohort was drawn prospectively from 276 maternity units in the United Kingdom and Ireland over a short period of time. This should accurately reflect expected outcomes from this population based on their current neonatal practice in 1995. If we can assume that the outcomes for extremely premature infants cared for in our NICUs is similar (a BIG assumption), then these data should be very useful in counseling parents who are confronted with the possibility of extremely premature delivery at < 26 weeks.
Andrew B. Kairalla MD