225 Changes In Survival And Neurodevelopmental Outcome in 22 to 25 Week Gestation Infants Over A 20 Year Period

Abstract

Background: Advances in neonatal care have resulted in the survival of increasing numbers of extremely preterm infants. There have been concerns that the improved survival of infants born at the limit of viability has resulted in infants surviving with significant disability who would have previously died. The aim of this study was to examine the change in survival over a 20 year period of infants born at less than 26 weeks gestation at a single tertiary referral centre and to correlate this with neurodevelopmental outcome at age 1 year.

Methods: All infants without major congenital abnormalities born at less than 26 weeks gestation and admitted to University College London Hospitals neonatal unit between 1981 and 2000 were prospectively recruited for long term follow-up. At one year of age corrected the infants were recalled. Each child underwent a Griffiths Developmental Assessment and an Amiel-Tison neurological examination. Neurological status was then classified as normal, impairment without disability or impairment with disability. The data were divided into 5 year blocks for analysis.

Results: A total of 353 infants fulfilled the recruitment criteria and were enrolled into the study. Of these 190 died and 159 were recalled at one year of age. Data on 4 infants was not available. Survival to one year during the time periods 1981–1985, 1986–1990, 1991–1995 and 1996–2000 was 32%, 34%, 46% and 71% respectively. The increased survival seen during the 1996–2000 period was statistically significant using Chi Squared analysis (p = 0.002). Statistical analysis of the Griffiths results was limited by modification of the test which resulted in restandardisation in 1996. This led to an overall reduction in the mean developmental quotient of 11 points in the normal population. For the infants in our study the mean total developmental quotient (DQ) during each of the time periods fell within the normal range. Values are shown in table 1. Analysis of the sub-scales revealed similar findings. The incidence of neurodisability was unchanged over the time periods (p= 0.18). See table 1.

Table 1

Conclusion: Our data show that despite a significant increase in the survival of infants born at less than 26 weeks gestation over a 20 year period there has been no significant increase in the incidence of adverse neurodevelopmental outcome in survivors.

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