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Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden

Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden
Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden
IMPORTANCE: 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).

DESIGN, SETTING, AND PARTICIPANTS: 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. MAIN OUTCOMES AND MEASURES: 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 AND RELEVANCE: 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.
0098-7484
1810-1820
Serenius, Fredrik
63f42df3-486d-4dab-bbbe-e335fc97d645
Källén, Karin
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Blennow, Mats
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Ewald, Uwe
5df39674-962f-4f36-87cb-ac088a044b44
Fellman, Vineta
e8c02f84-a805-48c7-bdd5-21fa767ed8a8
Holmström, Gerd
93d1dfa4-471e-4e40-8d4b-3a900e6daf3d
Lindberg, Eva
f3206dda-b55f-45be-b65c-45a3d16e3003
Lundqvist, Pia
030dac11-e4af-472d-80ec-e381209af080
Maršál, Karel
8dede649-0c85-4833-9692-9f2bfd860fe8
Norman, Mikael
ff5684df-1bc6-4d5d-8699-ecaddd74ccf3
Olhager, Elisabeth
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Stigson, Lennart
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Stjernqvist, Karin
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Vollmer, Brigitte
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Strömberg, Bo
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EXPRESS Group
Serenius, Fredrik
63f42df3-486d-4dab-bbbe-e335fc97d645
Källén, Karin
59e12ec5-ecb6-4daf-9a1c-be64f2713221
Blennow, Mats
14d9f9ca-4587-4372-b964-463355551e31
Ewald, Uwe
5df39674-962f-4f36-87cb-ac088a044b44
Fellman, Vineta
e8c02f84-a805-48c7-bdd5-21fa767ed8a8
Holmström, Gerd
93d1dfa4-471e-4e40-8d4b-3a900e6daf3d
Lindberg, Eva
f3206dda-b55f-45be-b65c-45a3d16e3003
Lundqvist, Pia
030dac11-e4af-472d-80ec-e381209af080
Maršál, Karel
8dede649-0c85-4833-9692-9f2bfd860fe8
Norman, Mikael
ff5684df-1bc6-4d5d-8699-ecaddd74ccf3
Olhager, Elisabeth
7b1ba08d-1974-45a1-b3cf-6f70cddb8c21
Stigson, Lennart
d569daeb-7ff7-46e9-878a-2ef30f725c28
Stjernqvist, Karin
5b649dbf-0585-44f0-ad44-e54ce5b7f9ab
Vollmer, Brigitte
044f8b55-ba36-4fb2-8e7e-756ab77653ba
Strömberg, Bo
796f7c64-580f-4051-8329-662b7599d092

Serenius, Fredrik, Källén, Karin, Blennow, Mats, Ewald, Uwe, Fellman, Vineta, Holmström, Gerd, Lindberg, Eva, Lundqvist, Pia, Maršál, Karel, Norman, Mikael, Olhager, Elisabeth, Stigson, Lennart, Stjernqvist, Karin, Vollmer, Brigitte and Strömberg, Bo , EXPRESS Group (2013) Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden. JAMA, 309 (17), 1810-1820. (doi:10.1001/jama.2013.3786). (PMID:23632725)

Record type: Article

Abstract

IMPORTANCE: 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).

DESIGN, SETTING, AND PARTICIPANTS: 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. MAIN OUTCOMES AND MEASURES: 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 AND RELEVANCE: 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.

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Published date: 1 May 2013
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 352163
URI: http://eprints.soton.ac.uk/id/eprint/352163
ISSN: 0098-7484
PURE UUID: 5e2876ae-4f9f-4dc8-ac67-44086d6b181c
ORCID for Brigitte Vollmer: ORCID iD orcid.org/0000-0003-4088-5336

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Date deposited: 03 May 2013 12:52
Last modified: 18 Feb 2021 17:15

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Contributors

Author: Fredrik Serenius
Author: Karin Källén
Author: Mats Blennow
Author: Uwe Ewald
Author: Vineta Fellman
Author: Gerd Holmström
Author: Eva Lindberg
Author: Pia Lundqvist
Author: Karel Maršál
Author: Mikael Norman
Author: Elisabeth Olhager
Author: Lennart Stigson
Author: Karin Stjernqvist
Author: Bo Strömberg
Corporate Author: EXPRESS Group

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