TY - JOUR
T1 - Two-year neurodevelopmental outcome in children born extremely preterm
T2 - The EPI-DAF study
AU - van Beek, Pauline E.
AU - Rijken, Monique
AU - Broeders, Lisa
AU - ter Horst, Hendrik J.
AU - Koopman-Esseboom, Corine
AU - de Kort, Ellen
AU - Laarman, C. leste
AU - Mulder-de Tollenaer, Susanne M.
AU - Steiner, Katerina
AU - Swarte, Renate M. C.
AU - van Westering-Kroon, Elke
AU - Oei, S. Guid
AU - Leemhuis, Aleid G.
AU - Andriessen, Peter
N1 - Funding Information: PB, MR, AL, PA and the EPI-DAF Study group contributed substantially to the methodological design of the study. MR, HH, CK, EK, CL, SM, KS, RS, EW and AGL contributed substantially to data acquisition, being the principal investigators of the 10 Dutch perinatal centres. PB, MR, LB, AL and PA contributed substantially to the analysis and interpretation of the data. PB wrote the first draft of the manuscript. PA was responsible for the financial funding of the project and supervised the project. PB and PA are guarantors of this study. Publisher Copyright: © 2022 Author(s) (or their employer(s)). Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Objective In 2010, the Dutch practice regarding initiation of active treatment in extremely preterm infants was lowered from 25 completed weeks' to 24 completed weeks' gestation. The nationwide Extremely Preterm Infants - Dutch Analysis on Follow-up Study was set up to provide up-to-date data on neurodevelopmental outcome at 2 years' corrected age (CA) after this guideline change. Design: National cohort study. Patients All live born infants between 24 0/7 weeks' and 26 6/7 weeks' gestational age who were 2 years' CA in 2018-2020. Main outcome measure Impairment at 2 years' CA, based on cognitive score (Bayley-III-NL), neurological examination and neurosensory function. Results 651 of 991 live born infants (66%) survived to 2 years' CA, with data available for 554 (85%). Overall, 62% had no impairment, 29% mild impairment and 9% moderate-to-severe impairment (further defined as neurodevelopmental impairment, NDI). The percentage of survivors with NDI was comparable for infants born at 24 weeks', 25 weeks' and 26 weeks' gestation. After multivariable analysis, severe brain injury and low maternal education were associated with higher odds on NDI. NDI-free survival was 48%, 67% and 75% in neonatal intensive care unit (NICU)-admitted infants at 24, 25 and 26 weeks' gestation, respectively. Conclusions Lowering the threshold has not been accompanied by a large increase in moderate-to-severely impaired infants. Among live-born and NICU-admitted infants, an increase in NDI-free survival was observed from 24 weeks' to 26 weeks' gestation. This description of a national cohort with high follow-up rates gives an accurate description of the range of outcomes that may occur after extremely preterm birth.
AB - Objective In 2010, the Dutch practice regarding initiation of active treatment in extremely preterm infants was lowered from 25 completed weeks' to 24 completed weeks' gestation. The nationwide Extremely Preterm Infants - Dutch Analysis on Follow-up Study was set up to provide up-to-date data on neurodevelopmental outcome at 2 years' corrected age (CA) after this guideline change. Design: National cohort study. Patients All live born infants between 24 0/7 weeks' and 26 6/7 weeks' gestational age who were 2 years' CA in 2018-2020. Main outcome measure Impairment at 2 years' CA, based on cognitive score (Bayley-III-NL), neurological examination and neurosensory function. Results 651 of 991 live born infants (66%) survived to 2 years' CA, with data available for 554 (85%). Overall, 62% had no impairment, 29% mild impairment and 9% moderate-to-severe impairment (further defined as neurodevelopmental impairment, NDI). The percentage of survivors with NDI was comparable for infants born at 24 weeks', 25 weeks' and 26 weeks' gestation. After multivariable analysis, severe brain injury and low maternal education were associated with higher odds on NDI. NDI-free survival was 48%, 67% and 75% in neonatal intensive care unit (NICU)-admitted infants at 24, 25 and 26 weeks' gestation, respectively. Conclusions Lowering the threshold has not been accompanied by a large increase in moderate-to-severely impaired infants. Among live-born and NICU-admitted infants, an increase in NDI-free survival was observed from 24 weeks' to 26 weeks' gestation. This description of a national cohort with high follow-up rates gives an accurate description of the range of outcomes that may occur after extremely preterm birth.
KW - Child health
KW - Epidemiology
KW - Infant development
KW - Intensive care units
KW - Neonatal
KW - Neonatology
UR - http://www.scopus.com/inward/record.url?scp=85136910161&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/archdischild-2021-323124
DO - https://doi.org/10.1136/archdischild-2021-323124
M3 - Article
C2 - 35236745
SN - 1359-2998
VL - 107
SP - 467
EP - 474
JO - Archives of disease in childhood. Fetal and neonatal edition
JF - Archives of disease in childhood. Fetal and neonatal edition
IS - 5
ER -