Outcome at 5 Years of Age of Children 23 to 27 Weeks' Gestation Treatment

Outcome at 5 Years of Age of Children 23 to 27 Weeks' Gestation  Treatment

Background: Parents who are counseled about the outcome for very preterm children want to know not only whether their child will survive but also whether survival will include a major sensorineural disability. There is variation in prognosis both between and within regions, reflecting to some extent different attitudes toward treatment. These regional differences should be reflected in the counseling that parents receive. Certain variables associated with adverse outcomes, diagnosed at different times, also will influence the prognosis. However, the method by which perinatal events and attitudes toward treatment combine to influence the prognosis for very preterm infants has not been well described. Survival to 5 years of age with and without major sensorineural disability was studied in very preterm infants to determine the changes with postnatal age, and the prognosis in these infants was compared with that of normal birth weight control infants.

Methods: This was a geographically determined cohort study conducted in Victoria, Australia, among consecutive infants of 23 to 27 weeks' gestational age born in 1999 and 1992. The control population comprised randomly selected normal birth weight infants. The main outcome measures were survival rate and rate of major disability at 5 years of age for infants who were offered intensive care, after day 7, after day 28, and at hospital discharge.

Results: From a total of 401 live births of 23 to 27 weeks' gestational age, 225 infants (56.1%) survived to 5 years of age. There was a significant increase in the survival rate with increasing gestational age at birth among infants offered intensive care and at day 7 but not at day 28. Although the survival rate free of major disability rose significantly with increasing gestational age at all postnatal ages, this was not an independent predictive variable by day 28. Other adverse events were found to be more predictive. In the absence of other adverse events, very preterm infants who survived to discharge had a survival rate free of major disability of 93.2%, a rate similar to the 95.5% rate for the normal birth weight control subjects.

Conclusions: There is a significant and substantial change with postnatal age in the prognosis of very preterm infants. Counseling of families should be repeated, and the nature of the advice given to parents should vary on the basis of perinatal events.