Elsevier

The Journal of Pediatrics

Volume 156, Issue 1, January 2010, Pages 49-53.e1
The Journal of Pediatrics

Original Article
Outcomes at Age 2 Years of Infants < 28 Weeks' Gestational Age Born in Victoria in 2005

https://doi.org/10.1016/j.jpeds.2009.07.013Get rights and content

Objective

To determine the survival rates and neurosensory outcomes of infants born at gestational age 22-27 weeks in the state of Victoria in 2005 and compare theses data with those for similar infants born in the 1990s.

Study design

This was a population-based study of all extremely preterm (22-27 weeks' gestational age) live births in Victoria in 2005 free of lethal anomalies and randomly selected term controls. Survival and quality-adjusted survival rates at age 2 years were determined relative to the controls, and results were compared with regional extremely preterm cohorts born in 1991-92 and 1997.

Results

Of 270 very preterm live births in 2005, 172 (63.7%) survived to 2 years, not significantly different from the survival rate of 69.6% for those born in 1997. Rates of severe developmental delay and severe disability were lower than in the very preterm survivors born in 1997. Quality-adjusted survival rates in the extremely preterm cohorts rose from 42.1% in 1991-92 to 55.1% in 1997, but did not increase in 2005 (53.4%).

Conclusions

Survival rates for infants born at 22-27 weeks' gestational age have not increased since the late 1990s, but the neurosensory outcome in survivors has improved.

Section snippets

Methods

All live-born infants at 22-27 completed weeks of gestation born in the state of Victoria in 2005 were included in this study, except for those live births resulting from termination of pregnancy secondary to lethal anomalies. Multiple data sources (the 4 level-III neonatal intensive care units in the state, the Newborn Emergency Transport Service, and the Victorian Perinatal Data Collection Unit) were cross-checked to verify the number of live births.5 Gestational age was determined by the

Results

The number of live births at 22-27 weeks' gestational age per year was 32% higher in 2005 (n = 288) compared with 1991-1992 (n = 219) (Table I). There were 18 live births from termination of pregnancy for lethal anomalies in 2005, compared with 5 per year in 1991-1992 and 6 in 1997; most terminations were born at 22 weeks' gestation. There were more very immature live births free of lethal anomalies per year in 2005 than in the other 2 eras: 23% were born at 22 or 23 weeks' gestation in 2005,

Discussion

Survival rates and quality-adjusted survival rates for very preterm infants in Victoria increased through the 1990s, but not in 2005. On the other hand, the rates of severe developmental delay and severe disability were significantly improved in 2005 compared with 1997. The finding of no blind children in the 2005 cohort was probably due to chance, because there have been no substantial changes in management of retinopathy of prematurity over this period.

Survival rates for infants of borderline

References (16)

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Supported in part by a grant from Health and Community Services, Victoria, and Project Grant 454413 from the National Health and Medical Research Council, Australia. The authors declare no conflicts of interest.

A list of additional members of the Victorian Infant Collaborative Study Group is available at www.jpeds.com (Appendix).

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