Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies.
Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies.
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DOI：
10.1136/bmj.e7961
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发表时间：
2012-12-04
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影响因子：
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通讯作者：
Marlow N
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作者：
Moore T;Hennessy EM;Myles J;Johnson SJ;Draper ES;Costeloe KL;Marlow N
目的了解2006年妊娠27周前出生的婴儿3岁时的结局，并评估自1995年以来妊娠22 - 25周出生的婴儿结局的变化。设计前瞻性国家队列研究，EPICure和EPICure 2。设置医院和家庭为基础的评估，英国。研究对象为2006年出生的1031名存活婴儿，妊娠期未满27周。将584例妊娠22-25周出生的婴儿的结局与1995年出生的260例相同胎龄的存活婴儿的结局进行比较。主要结果测量3岁生存率、损伤（2008年共识定义）和发育评分。使用多重插补来解释2006年队列中缺失数据的高比例。结果在2006年出生后接受评估的576名婴儿中，13.4%（n=77）被归类为重度损伤，11.8%（n=68）被归类为中度损伤。神经发育障碍的患病率与妊娠时间显著相关，随着胎龄的减少，神经发育障碍的患病率更高：22-23周为45%，24周为30%，25周为25%，26周为20%（P<0.001）。83例（14%）幸存者出现脑瘫。平均发育指数低于一般人群（正常值100（SD 15）），并与胎龄直接相关：22-23周80（SD 21），24周87（19），25周88（19），26周91（18）。插补后这些结果没有显着差异。比较2006年和1995年队列之间的插补结果，使用1995年的定义，妊娠22至25周出生的重度残疾幸存者比例在1995年为18%（95%置信区间14%至24%），2006年为19%（14%至23%）。脑积水或癫痫发作的幸存者较少。接受新生儿护理的婴儿存活率从39% 1995年（35%至43%）至52%（49%至55%），2006年增长13%无残疾存活率从1995年的23%（20%至26%）提高到2006年的34%（31%至37%），提高了11%（6%至16%）。 结论孕27周以内出生的婴儿，其早期存活率和早期功能损害均与胎龄密切相关。使用多重插补来解释高比例的缺失值，更高比例的新生儿护理入院的婴儿现在生存无残疾，特别是那些出生在胎龄24和25周。
Objective To determine outcomes at age 3 years in babies born before 27 completed weeks’ gestation in 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks’ gestation. Design Prospective national cohort studies, EPICure and EPICure 2. Setting Hospital and home based evaluations, England. Participants 1031 surviving babies born in 2006 before 27 completed weeks’ gestation. Outcomes for 584 babies born at 22-25 weeks’ gestation were compared with those of 260 surviving babies of the same gestational age born in 1995. Main outcome measures Survival to age 3 years, impairment (2008 consensus definitions), and developmental scores. Multiple imputation was used to account for the high proportion of missing data in the 2006 cohort. Results Of the 576 babies evaluated after birth in 2006, 13.4% (n=77) were categorised as having severe impairment and 11.8% (n=68) moderate impairment. The prevalence of neurodevelopmental impairment was significantly associated with length of gestation, with greater impairment as gestational age decreased: 45% at 22-23 weeks, 30% at 24 weeks, 25% at 25 weeks, and 20% at 26 weeks (P<0.001). Cerebral palsy was present in 83 (14%) survivors. Mean developmental quotients were lower than those of the general population (normal values 100 (SD 15)) and showed a direct relation with gestational age: 80 (SD 21) at 22-23 weeks, 87 (19) at 24 weeks, 88 (19) at 25 weeks, and 91 (18) at 26 weeks. These results did not differ significantly after imputation. Comparing imputed outcomes between the 2006 and 1995 cohorts, the proportion of survivors born between 22 and 25 weeks’ gestation with severe disability, using 1995 definitions, was 18% (95% confidence interval 14% to 24%) in 1995 and 19% (14% to 23%) in 2006. Fewer survivors had shunted hydrocephalus or seizures. Survival of babies admitted for neonatal care increased from 39% (35% to 43%) in 1995 to 52% (49% to 55%) in 2006, an increase of 13% (8% to 18%), and survival without disability increased from 23% (20% to 26%) in 1995 to 34% (31% to 37%) in 2006, an increase of 11% (6% to 16%). Conclusion Survival and impairment in early childhood are both closely related to gestational age for babies born at less than 27 weeks’ gestation. Using multiple imputation to account for the high proportion of missing values, a higher proportion of babies admitted for neonatal care now survive without disability, particularly those born at gestational ages 24 and 25 weeks.