title: Has the outcome for extremely low gestational age (ELGA) infants improved following recent advances in neonatal intensive care?
abstract: The objectives of this paper are to examine (a) the survival of extremely low-gestational-age (ELGA) infants born at 23-28 weeks' gestational age (GA) and (b) the neurodevelopmental outcome at 18 months corrected age for those born at 23-25 weeks' GA during 1991-1993, when antenatal steroids, surfactant, and dexamethasone for bronchopulmonary dysplasia had become accepted treatments; and to compare with an earlier (1983-1989), previously published large cohort (in a presurfactant era) from our institution. Perinatal and neonatal data on all births delivered at 23-28 weeks' GA at British Columbia's tertiary perinatal center were analyzed for survival rates by GA. Survivors of those born at 23-25 weeks' GA underwent neurodevelopmental assessment at a corrected chronological age of 18 months. The recent cohort (n = 333) of live birth infants, compared to the earlier cohort (n = 911 ) showed a trend toward an overall improved survival to discharge (72 vs. 65%, p = 0.06). Further analysis showed that improved survival was seen only in 26- to 28-week GA infants (86 vs. 76%, p = 0.01), but not in 23- to 25-week GA infants (44 vs. 44%, p = 0.9), even when adjusted for gender or twin births. In addition, the incidence of major impairment at 18 months (36% in both periods) remained high. Reanalysis of 24- to 25-week GA infants again showed no evidence of improved survival (53 vs. 50%) or improved outcome at 18 months (major handicap rate 32%; vs. 34%). Survival rates improved for 26- to 28-week GA infants, but the survival rate and incidence of major impairment had not improved for of 23- to 25-week GA infants.
authors.affiliation: Department of Pediatrics, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Battin
authors.forename: E W
authors.initials: EW
authors.lastname: Ling
authors.forename: M F
authors.initials: MF
authors.lastname: Whitfield
authors.forename: M
authors.initials: M
authors.lastname: Mackinnon
authors.forename: S B
authors.initials: SB
authors.lastname: Effer
mesh_terms: D000367:Age Factors; D001955:British Columbia / Q000453:epidemiology; D004992:Ethics, Medical; D005260:Female; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000639:trends*; D008297:Male; D012151:Resuscitation; D015996:Survival Rate