Skip to main content
PMC home page
Archives of Disease in Childhood. Fetal and Neonatal Edition logoLink to Archives of Disease in Childhood. Fetal and Neonatal Edition
. 1998 Mar;78(2):F99–F104. doi: 10.1136/fn.78.2.f99

Increased survival and deteriorating developmental outcome in 23 to 25 week old gestation infants, 1990-4 compared with 1984-9

H Emsley, S Wardle, D Sims, M Chiswick, S D'Souza
PMCID: PMC1720768  PMID: 9577278

Abstract

AIMS—To assess whether changes in survival over time in infants of 23 to 25 weeks of gestational age were accompanied by changes in the incidence of disability in childhood during an 11 year period.
METHODS—Obstetric and neonatal variables having the strongest association with both survival to discharge from a regional neonatal medical unit and neurodevelopmental disability in 192 infants of 23 to 25 weeks of gestation, born in 1984 to 1994, were studied as a group and in two cohorts (1984 to 1989 n = 96 and 1990 to 1994 n = 96). The data collected included CRIB (clinical risk index for babies) scores and cranial ultrasound scan findings. The children were followed up at outpatient clinics.
RESULTS—Between 1984 and 1989 (cohort 1) and 1990 and 1994 (cohort 2) the rate of survival to discharge increased significantly from 27% to 42% and the rate of disability in survivors increased from 38% to 68% ; most of this increase was in mild disability. The proportions of survivors with cerebral palsy did not alter significantly (21% vs 18%), but more survivors with blindness due to retinopathy of prematurity (4% vs 18%), myopia (4% vs 15%) and squints (8% vs 13%) contributed to the increased rate of disability. Clinically significant cranial ultrasound findings and a high CRIB score were strongly associated with death. A high CRIB score was most strongly associated with disability.
CONCLUSIONS—The rise in disability with improved survival was not due to cerebral palsy; rather the main contributors were blindness due to retinopathy, myopia, and squint. The causes of these disabilities seem to be linked to high CRIB scores. A system of regular and skilled retinal examination and access to facilities for retinal ablation should be in place in all neonatal units which undertake the care of such extremely preterm infants.



Full Text

The Full Text of this article is available as a PDF (119.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen M. C., Donohue P. K., Dusman A. E. The limit of viability--neonatal outcome of infants born at 22 to 25 weeks' gestation. N Engl J Med. 1993 Nov 25;329(22):1597–1601. doi: 10.1056/NEJM199311253292201. [DOI] [PubMed] [Google Scholar]
  2. Cooke R. W. Factors affecting survival and outcome at 3 years in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed. 1994 Jul;71(1):F28–F31. doi: 10.1136/fn.71.1.f28. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cooke R. W. Improved outcome for infants at the limits of viability. Eur J Pediatr. 1996 Aug;155(8):665–667. doi: 10.1007/BF01957149. [DOI] [PubMed] [Google Scholar]
  4. Hack M., Fanaroff A. A. Outcomes of extremely-low-birth-weight infants between 1982 and 1988. N Engl J Med. 1989 Dec 14;321(24):1642–1647. doi: 10.1056/NEJM198912143212405. [DOI] [PubMed] [Google Scholar]
  5. Hack M., Horbar J. D., Malloy M. H., Tyson J. E., Wright E., Wright L. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Network. Pediatrics. 1991 May;87(5):587–597. [PubMed] [Google Scholar]
  6. Hack M., Wright L. L., Shankaran S., Tyson J. E., Horbar J. D., Bauer C. R., Younes N. Very-low-birth-weight outcomes of the National Institute of Child Health and Human Development Neonatal Network, November 1989 to October 1990. Am J Obstet Gynecol. 1995 Feb;172(2 Pt 1):457–464. doi: 10.1016/0002-9378(95)90557-x. [DOI] [PubMed] [Google Scholar]
  7. Johnson A., Townshend P., Yudkin P., Bull D., Wilkinson A. R. Functional abilities at age 4 years of children born before 29 weeks of gestation. BMJ. 1993 Jun 26;306(6894):1715–1718. doi: 10.1136/bmj.306.6894.1715. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. La Pine T. R., Jackson J. C., Bennett F. C. Outcome of infants weighing less than 800 grams at birth: 15 years' experience. Pediatrics. 1995 Sep;96(3 Pt 1):479–483. [PubMed] [Google Scholar]
  9. Rennie J. M. Perinatal management at the lower margin of viability. Arch Dis Child Fetal Neonatal Ed. 1996 May;74(3):F214–F218. doi: 10.1136/fn.74.3.f214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Synnes A. R., Ling E. W., Whitfield M. F., Mackinnon M., Lopes L., Wong G., Effer S. B. Perinatal outcomes of a large cohort of extremely low gestational age infants (twenty-three to twenty-eight completed weeks of gestation). J Pediatr. 1994 Dec;125(6 Pt 1):952–960. doi: 10.1016/s0022-3476(05)82015-3. [DOI] [PubMed] [Google Scholar]
  11. Wariyar U., Richmond S., Hey E. Pregnancy outcome at 24-31 weeks' gestation: neonatal survivors. Arch Dis Child. 1989 May;64(5):678–686. doi: 10.1136/adc.64.5.678. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Whyte H. E., Fitzhardinge P. M., Shennan A. T., Lennox K., Smith L., Lacy J. Extreme immaturity: outcome of 568 pregnancies of 23-26 weeks' gestation. Obstet Gynecol. 1993 Jul;82(1):1–7. [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood. Fetal and Neonatal Edition are provided here courtesy of BMJ Publishing Group

RESOURCES