Long-term prognosis for extremely premature babies can change ‘rapidly’ post birth, study shows
For extremely preterm infants, changes occur rapidly after birth in terms of long-term prognosis and major neurodevelopmental disability, research finds.
This means that counselling of families and post-discharge planning should be individualised to changing circumstances following birth, said researchers.
The observational study used data from three geographical cohorts composed of all extremely preterm – that is, under 28 weeks’ gestation – livebirths offered intensive care at birth. All were within three distinct periods; 1991–92, 1997, and 2005 and were born in Victoria, Australia.
The study aimed to elucidate the changes in probability of three outcomes – death, survival with major disability, and survival without major disability – with postnatal age in extremely preterm infants offered intensive care, and the effect of postnatal events on the probability of survival without major disability.
It found that 751 (82%) of 915 extremely preterm livebirths free of lethal anomalies were offered intensive care, of whom 546 (73%) survived to age 8 years.
Of the 499 survivors assessed, 86 (17%) had a major disability.
With increasing gestational age at birth or days of postnatal survival, the probability of death decreased and of survival without major disability increased.
By contrast, the probability of survival with major disability varied little with gestational age or postnatal survival.
In survivors, major disability was associated with the occurrence of four important postnatal events: grade three or four intraventricular haemorrhage (odds ratio 2·61 [95% CI 1·11–6·15]), cystic periventricular leukomalacia (9·17 [3·57–23·53]), postnatal corticosteroid use (1·99 [1·03–3·85]), and surgery (2·78 [1·51–5·13]).
Nearly half – 48% (241) – of survivors had no major postnatal events during the newborn period, and had the lowest prevalence of major disability.
The full research, published in The Lancet, is available here.