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Andrew B. Kairalla MD, Editor

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Long-Term Outcomes in Micronates 

Neurologic and Developmental Disability at Six Years of Age after Extremely Preterm Birth.  Marlow N, Wolke D, and Bracewell MA.   NEJM 352:9-19.

Background: Birth before 26 weeks of gestation is associated with a high prevalence of neurologic and developmental disabilities in the infant during the first two years of life.

Methods: We studied at the time of early school age children who had been born at 25 or fewer completed weeks of gestation in the United Kingdom and Ireland in 1995. Each child had been evaluated at 30 months of age. The children underwent standardized cognitive and neurologic assessments at six years of age. Disability was defined as severe (indicating  dependence on caregivers), moderate, or mild according to predetermined criteria.

Results: Of 308 surviving children, 241 (78 percent) were assessed at a median age of six years and four months; 160 classmates delivered at full term served as a comparison group. Although the use of test reference norms showed that cognitive impairment (defined as results more than 2 SD below the mean) was present in 21 percent of the children born extremely preterm (as compared with 1 percent in the standardized data), this value rose to 41 percent when the results were compared with those for their classmates. The rates of severe, moderate, and mild disability were 22 percent, 24 percent, and 34 percent, respectively; disabling cerebral palsy was present in 30 children (12 percent). Among children with severe disability at 30 months of age, 86 percent still had moderate-to-severe disability at 6 years of age. In contrast, other disabilities at the age of 30 months were poorly predictive of developmental problems at 6 years of age.

Conclusions:   Among extremely preterm children, cognitive and neurologic impairment is common at school age. A comparison with their classroom peers indicates a level of impairment that is greater than is recognized with the use of standardized norms.

Comments:  This study is a follow up to the EpiCure study that looked at neurodevelopmental outcomes of all infants born at less than 26 weeks gestation in England and Ireland in 1995 (see NeoNotes 1-025 and 1-026 for earlier discussion of this study).  The current report updates their outcomes when the survivors reached school age.  Of these micro-preemies who survived to school age, roughly ¼ had severe disabilities, ¼ had moderate disabilities, and half were classified as having either mild disability (34%) or no disability (20%).  The infants with severe disability mostly had cognitive impairment (21%), followed by non-ambulatory cerebral palsy (6%), deafness (3%) and blindness (2%). 

Special thanks to Dr. Cristof Kluthe from Berlin Germany for suggesting this article for our review.  Dr Kluthe writes:
“I think this is one of the most interesting articles we have concerning the outcome of our patients and would appreciate a discussion. From my point of view the death rate is really high and I am missing the population data like birth weight, APGAR surfactant etc.”              ABK.

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