title: Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden.
abstract: OBJECTIVE
  Active perinatal care increases survival of extremely preterm infants; however, improved survival might be associated with increased disability among survivors.
  
  
  OBJECTIVE
  To determine neurodevelopmental outcome in extremely preterm children at 2.5 years (corrected age).
  
  
  METHODS
  Population-based prospective cohort of consecutive extremely preterm infants born before 27 weeks of gestation in Sweden between 2004 and 2007. Of 707 live-born infants, 491 (69%) survived to 2.5 years. Survivors were assessed and compared with singleton control infants who were born at term and matched by sex, ethnicity, and municipality. Assessments ended in February 2010 and comparison estimates were adjusted for demographic differences.
  
  
  METHODS
  Cognitive, language, and motor development was assessed with Bayley Scales of Infant and Toddler Development (3rd edition; Bayley-lll), which are standardized to mean (SD) scores of 100 (15). Clinical examination and parental questionnaires were used for diagnosis of cerebral palsy and visual and hearing impairments. Assessments were made by week of gestational age.
  
  
  RESULTS
  At a median age of 30.5 months (corrected), 456 of 491 (94%) extremely preterm children were evaluated (41 by chart review only). For controls, 701 had information on health status and 366 had Bayley-lll assessments. Mean (SD) composite Bayley-III scores (cognition, 94 [12.3]; language, 98 [16.5]; motor, 94 [15.9]) were lower than the corresponding mean scores for controls (cognition, 104 [10.6]; P < .001; adjusted difference in mean scores, 9.2 [99% CI, 6.9-11.5]; language, 109 [12.3]; P < .001; adjusted difference in mean scores, 9.3 [99% Cl, 6.4-12.3]; and motor, 107 [13.7]; P < .001; adjusted difference in mean scores, 12.6 [99% Cl, 9.5-15.6]). Cognitive disability was moderate in 5% of the extremely preterm group vs 0.3% in controls (P < .001) and it was severe in 6.3% of the extremely preterm group vs 0.3% in controls (P < .001). Language disability was moderate in 9.4% of the extremely preterm group vs 2.5% in controls (P < .001) and severe in 6.6% of the extremely preterm group vs 0% in controls (P < .001). Other comparisons between the extremely preterm group vs controls were for cerebral palsy (7.0% vs 0.1%; P < .001), for blindness (0.9% vs 0%; P = .02), and for hearing impairment (moderate and severe, 0.9% vs 0%; P = .02, respectively). Overall, 42% (99% CI, 36%-48%) of extremely preterm children had no disability, 31% (99% CI, 25%-36%) had mild disability, 16% (99% CI, 12%-21%) had moderate disability, and 11% (99% CI, 7.2%-15%) had severe disability. Moderate or severe overall disability decreased with gestational age at birth (22 weeks, 60%; 23 weeks, 51%; 24 weeks, 34%; 25 weeks, 27%; and 26 weeks, 17%; P for trend < .001).
  
  
  CONCLUSIONS
  Of children born extremely preterm and receiving active perinatal care, 73% had mild or no disability and neurodevelopmental outcome improved with each week of gestational age. These results are relevant for clinicians counseling families facing extremely preterm birth.
authors: Department of Women's and Children's Health, Section for Pediatrics, Uppsala University, S-751 85 Uppsala, Sweden. fredrik.serenius@kbh.uu.se
authors: Fredrik
authors: F
authors: Serenius
authors: Karin
authors: K
authors: Källén
authors: Mats
authors: M
authors: Blennow
authors: Uwe
authors: U
authors: Ewald
authors: Vineta
authors: V
authors: Fellman
authors: Gerd
authors: G
authors: Holmström
authors: Eva
authors: E
authors: Lindberg
authors: Pia
authors: P
authors: Lundqvist
authors: Karel
authors: K
authors: Maršál
authors: Mikael
authors: M
authors: Norman
authors: Elisabeth
authors: E
authors: Olhager
authors: Lennart
authors: L
authors: Stigson
authors: Karin
authors: K
authors: Stjernqvist
authors: Brigitte
authors: B
authors: Vollmer
authors: Bo
authors: B
authors: Strömberg
mesh_terms: D001766:Blindness; D016022:Case-Control Studies; D002547:Cerebral Palsy; D002657:Child Development; D002675:Child, Preschool; D003071:Cognition; D002658:Developmental Disabilities; D019988:Children with Disabilities / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature / Q000502:physiology / Q000523:psychology; D007231:Infant, Newborn; D007234:Infant, Premature; D007804:Language Development; D008297:Male; D018743:Perinatal Care; D047928:Premature Birth; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D017741:Survivors; D013548:Sweden; D016896:Treatment Outcome