title: Early-childhood neurodevelopmental outcomes are not improving for infants born at <25 weeks' gestational age.
abstract: OBJECTIVE
  We compared neurodevelopmental outcomes at 18 to 22 months' corrected age of infants born with extremely low birth weight at an estimated gestational age of <25 weeks during 2 periods: 1999-2001 (epoch 1) and 2002-2004 (epoch 2).
  
  
  METHODS
  We conducted a multicenter, retrospective analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Perinatal and neonatal variables and outcomes were compared between epochs. Neurodevelopmental outcomes at 18 to 22 months' corrected age were evaluated with neurologic exams and Bayley Scales of Infant Development II. Logistic regression analyses determined the independent risk of epoch for adverse outcomes.
  
  
  RESULTS
  Infant survival was similar between epochs (epoch 1, 35.4%, vs epoch 2, 32.3%; P = .09). A total of 411 of 452 surviving infants in epoch 1 and 405 of 438 surviving infants in epoch 2 were evaluated at 18 to 22 months' corrected age. Cesarean delivery (P = .03), surgery for patent ductus arteriosus (P = .004), and late sepsis (P = .01) were more common in epoch 2, but postnatal steroid use was dramatically reduced (63.5% vs 32.8%; P < .0001). Adverse outcomes at 18 to 22 months' corrected age were common in both epochs. Moderate-to-severe cerebral palsy was diagnosed in 11.1% of surviving infants in epoch 1 and 14.9% in epoch 2 (adjusted odds ratio [OR]: 1.52 [95% confidence interval (CI): 0.86-2.71]; P = .15), the Mental Developmental Index was <70 in 44.9% in epoch 1 and 51% in epoch 2 (OR: 1.30 [95% CI: 0.91-1.87]; P = .15), and neurodevelopmental impairment was diagnosed in 50.1% of surviving infants in epoch 1 and 58.7% in epoch 2 (OR: 1.4 [95% CI: 0.98-2.04]; P = .07).
  
  
  CONCLUSIONS
  Early-childhood outcomes for infants born at <25 weeks' estimated gestational age were unchanged between the 2 periods.
authors.affiliation: Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304, USA. srhintz@stanford.edu
authors.forename: Susan R
authors.initials: SR
authors.lastname: Hintz
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Kendrick
authors.forename: Deanne E
authors.initials: DE
authors.lastname: Wilson-Costello
authors.forename: Abhik
authors.initials: A
authors.lastname: Das
authors.forename: Edward F
authors.initials: EF
authors.lastname: Bell
authors.forename: Betty R
authors.initials: BR
authors.lastname: Vohr
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Higgins
mesh_terms: D000367:Age Factors; D002658:Developmental Disabilities / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology*; D012189:Retrospective Studies