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Rates of neurodevelopmental outcomes among survivors in selected studies for infants 22 to 25 weeks gestation

Rates of neurodevelopmental outcomes among survivors in selected studies for infants 22 to 25 weeks gestation
Study Study year Outcome Rate (%) by gestational week Comment
22 23 24 25 Total
Bell[1] 2013 to 2016 Moderate to severe CP 23 18 11 6 10 Defined as GMFCS level 2 or greater
Cognitive impairment 26 23 21 12 17 Defined as Bayley-III composite cognitive score <70
Motor impairment 23 28 22 12 18 Defined as Bayley-III composite motor score <70
Younge[2] 2000 to 2003 Impairment 67 65 44 N/A N/A Neurodevelopmental impairment assessed at 18 to 24 months and defined as: Moderate or severe CP, moderate to severe gross motor impairment, deafness, blindness, or cognitive impairment based on Bayley-II (2000 to 2005) or Bayley-III (2006 to 2011) scores
2004 to 2007 Impairment 69 43 45 N/A N/A
2008 to 2011 Impairment 63 46 42 N/A N/A
Carlo[3] 1993 to 2009 Impairment MDI or PDI ≤70, moderate or severe CP, blindness, or bilateral hearing loss requiring amplification at 18 to 22 months corrected age
ANS 59 55 42 34 39
No ANS 56 56 52 44 49
CP Moderate or severe CP
ANS 14 11 10 7 9
No ANS 16 19 12 9 12
Serenius[4] 2004 to 2007 Mild 40 19 33 29 29 Mild disability: scores on any Bayley-III scales between 1 and 2 SD below the mean or mild CP at 2.5 years corrected age
Moderate 20 30 21 17 20 Moderate disability: scores on any Bayley-III scales between 2 and 3 SD below the mean, moderate CP, or moderate visual or hearing impairment at 2.5 years corrected age
Severe 40 21 13 10 13 Severe disability: score >3 SD below the mean for any of the Bayley-III scales, severe CP, or bilateral blindness or deafness at 2.5 years corrected age
EPICure2[5] 2006 Severe Impairment 10 29 19 16 10 Neurodevelopmental impairment assessed between 27 and 48 months of age. Severe impairment defined as blindness, non-ambulant CP, deafness, and a developmental quotient (DQ) <3 SD below the mean. Moderate impairment defined as ambulant CP, functionally impaired vision, hearing loss improved by hearing aids, and DQ between 2 and 3 SD.
Moderate impairment 42 18 16 12 10
Ishii[6] 2003 to 2005 Impairment 52 57 37 37 42 Moderate to severe CP, hearing impairment requiring amplification, blindness in one or both eyes, or a score of <70 at 36 to 42 months corrected age on the Kyoto Scale of Psychological Development (KSPD)
Profound impairment 30 40 16 17 23 Severe CP or a score <50 at 36 to 42 months corrected age on KSPD
Tyson[7] 1998 to 2003 Impairment 80 65 50 36 47 MDI or PDI <70, moderate or severe CP, blindness, or bilateral hearing loss requiring amplification at 18 to 22 months corrected age
Profound impairment 60 38 23 17 24 MDI or PDI <50 or severe gross motor deficit requiring adult assistance to move at 18 to 22 months corrected age
Epipage[8] 1997 CP N/A 33 13 16.3 16 As defined by European Surveillance of CP Network at two years
Cognitive score <70 N/A 0 23 12 14 K-ABC test at five to six years in 57% of children without severe disability
EPICure1[9] 1995 CP N/A 13 21 20 20 As defined by European Surveillance of CP Network at two years
Cognitive score <70 N/A 11 14 7 10 K-ABC test at five to six years in 64% of children without severe disability
CP: cerebral palsy; N/A: not available; K-ABC test: Mental Processing Composite of the Kaufman Assessment Battery for Children; MDI: Mental Developmental Index of the Bayley Scales of Infant Development-II; PDI: Psychomotor Developmental Index of the Bayley Scales of Infant Development-II; ANS: antenatal steroid therapy; SD: standard deviation; GMFCS: gross motor function classification system.
References:
  1. Bell EF, Hintz SR, Hansen NI, et al. Mortality, In-Hospital Morbidity, Care Practices, and 2-Year Outcomes for Extremely Preterm Infants in the US, 2013-2018. JAMA 2022; 327:248.
  2. Younge N, Goldstein RF, Bann CM, et al. Survival and Neurodevelopmental Outcomes among Periviable Infants. N Engl J Med 2017; 376:617.
  3. Carlo WA, McDonald SA, Fanaroff AA, et al. Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation. JAMA 2011; 306:2348.
  4. Serenius F, Källén K, Blennow M, et al. Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden. JAMA 2013; 309:1810.
  5. Moore T, Hennessy EM, Myles J, et al. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ 2012; 345:e7961.
  6. Ishii N, Kono Y, Yonemoto N, et al. Outcomes of infants born at 22 and 23 weeks' gestation. Pediatrics 2013; 132:62.
  7. Tyson JE, Parikh NA, Langer J, et al. Intensive care for extreme prematurity--moving beyond gestational age. N Engl J Med 2008; 358:1672.
  8. Larroque B, Bréart G, Kaminski M, et al. Survival of very preterm infants: Epipage, a population based cohort study. Arch Dis Child Fetal Neonatal Ed 2004; 89:F139.
  9. Costeloe K, Hennessy E, Gibson AT, et al. The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics 2000; 106:659.
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