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Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies).
BMJ. 2012 Dec 04; 345:e7976.BMJ

Abstract

OBJECTIVE

To determine survival and neonatal morbidity for babies born between 22 and 26 weeks' gestation in England during 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks' gestation.

DESIGN

Prospective national cohort studies.

SETTING

Maternity and neonatal units in England.

PARTICIPANTS

3133 births between 22 and 26 weeks' gestation in 2006; 666 admissions to neonatal units in 1995 and 1115 in 2006 of babies born between 22 and 25 weeks' gestation.

MAIN OUTCOME MEASURES

Survival to discharge from hospital, pregnancy and delivery outcomes, infant morbidity until discharge.

RESULTS

In 2006, survival of live born babies was 2% (n=3) for those born at 22 weeks' gestation, 19% (n=66) at 23 weeks, 40% (n=178) at 24 weeks, 66% (n=346) at 25 weeks, and 77% (n=448) at 26 weeks (P<0.001). At discharge from hospital, 68% (n=705) of survivors had bronchopulmonary dysplasia (receiving supplemental oxygen at 36 weeks postmenstrual age), 13% (n=135) had evidence of serious abnormality on cerebral ultrasonography, and 16% (n=166) had laser treatment for retinopathy of prematurity. For babies born between 22 and 25 weeks' gestation from March to December, the number of admissions for neonatal care increased by 44%, from 666 in 1995 to 959 in 2006. By 2006 adherence to evidence based practice associated with improved outcome had significantly increased. Survival increased from 40% to 53% (P<0.001) overall and at each week of gestation: by 9.5% (confidence interval -0.1% to 19%) at 23 weeks, 12% (4% to 20%) at 24 weeks, and 16% (9% to 23%) at 25 weeks. The proportions of babies surviving in 2006 with bronchopulmonary dysplasia, major cerebral scan abnormality, or weight and/or head circumference <-2 SD were similar to those in 1995, but the proportion treated for retinopathy of prematurity had increased from 13% to 22% (P=0.006). Predictors of mortality and morbidity were similar in both cohorts.

CONCLUSION

Survival of babies born between 22 and 25 weeks' gestation has increased since 1995 but the pattern of major neonatal morbidity and the proportion of survivors affected are unchanged. These observations reflect an important increase in the number of preterm survivors at risk of later health problems.

Authors+Show Affiliations

Centre For Paediatrics, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. k.l.costeloe@qmul.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23212881

Citation

Costeloe, Kate L., et al. "Short Term Outcomes After Extreme Preterm Birth in England: Comparison of Two Birth Cohorts in 1995 and 2006 (the EPICure Studies)." BMJ (Clinical Research Ed.), vol. 345, 2012, pp. e7976.
Costeloe KL, Hennessy EM, Haider S, et al. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ. 2012;345:e7976.
Costeloe, K. L., Hennessy, E. M., Haider, S., Stacey, F., Marlow, N., & Draper, E. S. (2012). Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ (Clinical Research Ed.), 345, e7976. https://doi.org/10.1136/bmj.e7976
Costeloe KL, et al. Short Term Outcomes After Extreme Preterm Birth in England: Comparison of Two Birth Cohorts in 1995 and 2006 (the EPICure Studies). BMJ. 2012 Dec 4;345:e7976. PubMed PMID: 23212881.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). AU - Costeloe,Kate L, AU - Hennessy,Enid M, AU - Haider,Sadia, AU - Stacey,Fiona, AU - Marlow,Neil, AU - Draper,Elizabeth S, Y1 - 2012/12/04/ PY - 2012/12/6/entrez PY - 2012/12/6/pubmed PY - 2013/2/6/medline SP - e7976 EP - e7976 JF - BMJ (Clinical research ed.) JO - BMJ VL - 345 N2 - OBJECTIVE: To determine survival and neonatal morbidity for babies born between 22 and 26 weeks' gestation in England during 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks' gestation. DESIGN: Prospective national cohort studies. SETTING: Maternity and neonatal units in England. PARTICIPANTS: 3133 births between 22 and 26 weeks' gestation in 2006; 666 admissions to neonatal units in 1995 and 1115 in 2006 of babies born between 22 and 25 weeks' gestation. MAIN OUTCOME MEASURES: Survival to discharge from hospital, pregnancy and delivery outcomes, infant morbidity until discharge. RESULTS: In 2006, survival of live born babies was 2% (n=3) for those born at 22 weeks' gestation, 19% (n=66) at 23 weeks, 40% (n=178) at 24 weeks, 66% (n=346) at 25 weeks, and 77% (n=448) at 26 weeks (P<0.001). At discharge from hospital, 68% (n=705) of survivors had bronchopulmonary dysplasia (receiving supplemental oxygen at 36 weeks postmenstrual age), 13% (n=135) had evidence of serious abnormality on cerebral ultrasonography, and 16% (n=166) had laser treatment for retinopathy of prematurity. For babies born between 22 and 25 weeks' gestation from March to December, the number of admissions for neonatal care increased by 44%, from 666 in 1995 to 959 in 2006. By 2006 adherence to evidence based practice associated with improved outcome had significantly increased. Survival increased from 40% to 53% (P<0.001) overall and at each week of gestation: by 9.5% (confidence interval -0.1% to 19%) at 23 weeks, 12% (4% to 20%) at 24 weeks, and 16% (9% to 23%) at 25 weeks. The proportions of babies surviving in 2006 with bronchopulmonary dysplasia, major cerebral scan abnormality, or weight and/or head circumference <-2 SD were similar to those in 1995, but the proportion treated for retinopathy of prematurity had increased from 13% to 22% (P=0.006). Predictors of mortality and morbidity were similar in both cohorts. CONCLUSION: Survival of babies born between 22 and 25 weeks' gestation has increased since 1995 but the pattern of major neonatal morbidity and the proportion of survivors affected are unchanged. These observations reflect an important increase in the number of preterm survivors at risk of later health problems. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/23212881/Short_term_outcomes_after_extreme_preterm_birth_in_England:_comparison_of_two_birth_cohorts_in_1995_and_2006__the_EPICure_studies__ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&amp;pmid=23212881 DB - PRIME DP - Unbound Medicine ER -