Two-year neurodevelopmental outcome in children born extremely preterm: The EPI-DAF study

Pauline E. Van Beek*, Monique Rijken, Lisa Broeders, Hendrik J. Ter Horst, Corine Koopman-Esseboom, Ellen De Kort, Céleste Laarman, Susanne M. Mulder-De Tollenaer, Katerina Steiner, Renate M.C. Swarte, Elke Van Westering-Kroon, S. Guid Oei, Aleid G. Leemhuis, Peter Andriessen

*Corresponding author for this work

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Abstract

Objective In 2010, the Dutch practice regarding initiation of active treatment in extremely preterm infants was lowered from 25 completed weeks' to 24 completed weeks' gestation. The nationwide Extremely Preterm Infants - Dutch Analysis on Follow-up Study was set up to provide up-to-date data on neurodevelopmental outcome at 2 years' corrected age (CA) after this guideline change. Design: National cohort study. Patients All live born infants between 240/7 weeks' and 266/7 weeks' gestational age who were 2 years' CA in 2018-2020. Main outcome measure Impairment at 2 years' CA, based on cognitive score (Bayley-III-NL), neurological examination and neurosensory function. Results 651 of 991 live born infants (66%) survived to 2 years' CA, with data available for 554 (85%). Overall, 62% had no impairment, 29% mild impairment and 9% moderate-to-severe impairment (further defined as neurodevelopmental impairment, NDI). The percentage of survivors with NDI was comparable for infants born at 24 weeks', 25 weeks' and 26 weeks' gestation. After multivariable analysis, severe brain injury and low maternal education were associated with higher odds on NDI. NDI-free survival was 48%, 67% and 75% in neonatal intensive care unit (NICU)-admitted infants at 24, 25 and 26 weeks' gestation, respectively. Conclusions Lowering the threshold has not been accompanied by a large increase in moderate-to-severely impaired infants. Among live-born and NICU-admitted infants, an increase in NDI-free survival was observed from 24 weeks' to 26 weeks' gestation. This description of a national cohort with high follow-up rates gives an accurate description of the range of outcomes that may occur after extremely preterm birth.

Original languageEnglish
Pages (from-to)467-474
Number of pages8
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
Volume107
Issue number5
DOIs
Publication statusPublished - 18 Aug 2022

Bibliographical note

Funding This project has been funded by an unrestricted grant from Stichting Tiny & Anny van Doorne Fonds. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2022 Author(s) (or their employer(s)). Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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