Elsevier

Seminars in Perinatology

Volume 25, Issue 5, October 2001, Pages 348-359
Seminars in Perinatology

The outcome of extreme prematurity

https://doi.org/10.1053/sper.2001.27164Get rights and content

Significant advances in perinatology and neonatology in the last decade have resulted in increased survival of extremely premature infants. Survival rates for infants born in tertiary perinatal and neonatal care centers in the United States in the 1990s increase with each week of gestational age from 22 through 26 weeks. Reported survival rates at 22 weeks range from 0% to 21% in the few reporting studies. Reported survival rates at 23 and 24 weeks range from 5% to 46% and from 40% to 59%, respectively. These may not be the maximum survival rates possible because at these gestational ages information is either insufficient to determine that obstetric and neonatal intensive care strategies to maximize neonatal survival were used or it is specified that such strategies were not used. Reported survival rates at 25 and 26 weeks range from 60% to 82% and from from 75% to 93%, respectively. The literature regarding the prevalence of major neurodevelopmental disabilities among extremely premature survivors in the last 25 years is heteogeneous, and the reported prevalances of major disability vary much more than do survival rates. However, the majority of extremely premature infants who survive will be free of major disability. Overall, approximately one fifth to one quarter of survivors have at least one major disability-impaired mental development, cerebral palsy, blindness, or deafness. Impaired mental development is the most prevalent disability (17%–21% [95% CI] of survivors affected), followed by cerebral palsy (12%–15% of survivors affected). Blindness and deafness are less common (5% to 8% and 3% to 5% of survivors affected, respectively). Approximately one half of disabled survivors have more than one major disability. Based on studies of infants less than 750 to 1,000 grams birth weight, it can be anticipated that approximately another half of all extremely premature survivors will have one or more subtle neurodevelopmental disabilities in the school and teenage years. There is little evidence to suggest that long-term neurodevelopmental outcome has changed from the late 1970s to the early 1990s or with increasing survival. Survival of individual extremely premature infants cannot be accurately predicted in the immediate perinatal period. Major disability cannot be accurately predicted for individual survivors during the course in the newborn intensive care unit.

References (83)

  • BattonDG et al.

    The impact of fetal compromise on outcome at the border of viability

    Am J Obstet Gynecol

    (1998)
  • TeplinSW et al.

    Neurodevelopmental, health, and growth status at age 6 years of children with birthweights less than 1001 grams

    J Pediatr

    (1991)
  • LesterBM et al.

    Relationship between risk and protective factors, developmental outcome, and the home environment at four years of age in term and preterm infants

  • NwaeseiCG et al.

    Preterm birth at 23 to 26 weeks' gestation: Is active obstetric management justified?

    Am J Obstet Gynecol

    (1987)
  • Outcome at two years of children 23–27 weeks' gestation born in Victoria in 1991–92

    J Pacdiatr Child Health

    (1997)
  • PiecuchRE et al.

    Outcome of infants born at 24–26 weeks' gestation: II. Neurodevelopmental outcome

    Obstet Gynecol

    (1997)
  • HackM et al.

    Outcomes of extremely low birth weight infants

    Pediatr

    (1996)
  • PiecuchRE et al.

    Outcome of extremely low birth weight infants (500 to 999 Grams) over a 12-year period

    Pediatr

    (1997)
  • RichardsonDK et al.

    Declining severity adjusted mortality: Evidence of improving neonatal intensive care

    Pediatrics

    (1998)
  • HackM et al.

    Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Network

    Pediatr

    (1991)
  • KramerMS et al.

    The validity of gestational age estimation by menstrual dating in term, preterm, and postterm gestations

    JAMA

    (1998)
  • MilnerRDG et al.

    An analysis of birth weight by gestational age of infants born in England and Wales 1967 to 1971

    Br Obstet Gynaecol Br Commonwealth

    (1974)
  • TysonJE et al.

    Viability, mortality, and resource use among newborns of 501–800-g birth weight

    JAMA

    (1996)
  • LorenzJM et al.

    A quantitative review of mortality and developmental disability in extremely premature newborns

    Arch Pediatr Adolesc Med

    (1998)
  • BardinC et al.

    Outcome for small-for-gestational age and appropriate-for-gestational age infants born before 27 weeks of gestation

    Pediatr

    (1997)
  • CookeRW

    Improved outcome for infants at the limit of viability

    Eur J Pediatr

    (1996)
  • LemonsJA et al.

    Very low birth weight out-comes of the National Institute of Child Heath and Human Development Neonatal Research Network, January 1995 through December 1996

    Pediatr

    (2000)
  • BattinM et al.

    Has the out-come for extremely low gestational age (ELGA) infants improved following recent advances in neonatal intensive care?

    Am J Perinatol

    (1998)
  • ShlossmanPA et al.

    An analysis of neonatal morbidity and mortality in maternal (in utero) and neonatal transports at 24–34 weeks gestation

    Am J Perinatol

    (1997)
  • The effect of corticosteroids for fetal maturation and perinatal outcomes

    NIH Concensus Statement

    (1994)
  • CookeRWI

    Factors affecting survival and outcome at 3 years in extremely preterm infants

    Arch Dis Child

    (1994)
  • DavisDJ

    How aggressive should delivery room cardiopulmonary resuscitation be for extremely low birth weight infants?

    Pediatr

    (1993)
  • RichardsonDK et al.

    Perinatal risk and severity of illness in newborns in 6 neonatal intensive care units

    Am J Public Health

    (1999)
  • AllenMC et al.

    The limit of viability—Neonatal outcome of infants born at 22 to 25 weeks' gestation

    N Engl J Med

    (1993)
  • HussainN et al.

    Pre-discharge outcomes of 22–27 weeks gestational age infants born at tertiary care centers in Connecticut: Implications for perinatal management

    Connecticut Med

    (1998)
  • LeblancMH et al.

    Long-term outcome of infants at the margin of viability

    Journal MSMA

    (1999)
  • TinW et al.

    Changing prognosis for babies born less than 28 week's gestation in the north of England between 1983 and 1994

    BMJ

    (1997)
  • HoekstraRE et al.

    Effects of surfactant therapy on outcome of extremely premature infants

    Eur J Pediatr

    (1994)
  • HackM et al.

    Neuro-development and predictors of outcomes of children with birth weights of less than 1000 g

    Arch Pediatr Adolesc Med

    (2000)
  • WoodNS et al.

    Neurologic and developmental disability after extreme prematurity

    N Engl J Med

    (2000)
  • MsallME et al.

    Functional outcomes in selfcare, mobility, communication, and learning in ex

    Clin Perinatol

    (2000)
  • Cited by (0)

    View full text