TY - JOUR
T1 - Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age
T2 - The EPI-DAF study
AU - Van Beek, Pauline E.
AU - Rijken, Monique
AU - Broeders, Lisa
AU - Ter Horst, Hendrik J.
AU - Koopman-Esseboom, Corine
AU - De Kort, Ellen
AU - Laarman, A. R.C.
AU - Mulder - De Tollenaer, S. M.
AU - Steiner, Katerina
AU - Swarte, Renate M.C.
AU - Van Westering-Kroon, Elke
AU - Oei, Guid
AU - Leemhuis, Aleid G.
AU - Andriessen, Peter
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2024.
PY - 2024/5/1
Y1 - 2024/5/1
N2 - Objective: After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks' gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed. Design: Population-based cohort study. Setting: All neonatal intensive care units in the Netherlands. Patients: All infants born between 240/7 and 266/7 weeks' gestation who were 5.5 years' corrected age (CA) in 2018-2020 were included. Main outcome measures: Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme. Results: In the 3-year period, a total of 632 infants survived to 5.5 years' CA. Data were available for 484 infants (77%). At 5.5 years' CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks' gestation, respectively (p<0.001). Conclusions: After lowering the threshold for supporting active treatment from 25 to 24 completed weeks' gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years' CA.
AB - Objective: After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks' gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed. Design: Population-based cohort study. Setting: All neonatal intensive care units in the Netherlands. Patients: All infants born between 240/7 and 266/7 weeks' gestation who were 5.5 years' corrected age (CA) in 2018-2020 were included. Main outcome measures: Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme. Results: In the 3-year period, a total of 632 infants survived to 5.5 years' CA. Data were available for 484 infants (77%). At 5.5 years' CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks' gestation, respectively (p<0.001). Conclusions: After lowering the threshold for supporting active treatment from 25 to 24 completed weeks' gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years' CA.
UR - http://www.scopus.com/inward/record.url?scp=85178621508&partnerID=8YFLogxK
U2 - 10.1136/archdischild-2023-325732
DO - 10.1136/archdischild-2023-325732
M3 - Article
C2 - 38071564
AN - SCOPUS:85178621508
SN - 1359-2998
VL - 109
SP - 272
EP - 278
JO - Archives of Disease in Childhood: Fetal and Neonatal Edition
JF - Archives of Disease in Childhood: Fetal and Neonatal Edition
IS - 3
M1 - archdischild-2023-325732
ER -