Neurological and Developmental Outcome in Extremely Preterm Children Born in England in 1995 and 2006: The EPICure Studies

Survival rates for babies born extremely prematurely increased between 1995 and 2006, but few improvements in neonatal morbidity occurred despite appropriate interventions. The current study was undertaken to examine the neurologic and developmental outcomes for babies born at less than 27 weeks’ gestation in 2006 and to compare the survival and outcomes at 3 years of age with those of babies born at 22 to 25 weeks’ gestation in 1995. Data were collected for all babies born at 22 to 26 weeks’ gestation during 2006. Families were contacted for assessment when the children were aged 30 to 36 months. In 1995, data were collected for babies born at 22 to 25 weeks’ gestation. Cerebral palsy was identified by neurologic examination and classified as severe, moderate, and mild, or no impairment in motor, developmental, sensory, and communication domains. Data from these 1995 and 2006 cohorts were combined to allow comparisons after reclassification of 2006 outcomes using the 1995 definitions. A total of 576 children, aged 27 to 48 months, were evaluated in person. Information was available from local data records for another 191 children, aged 18 to 50 months, of whom 68 (38%) had neurodevelopmental impairment. Of babies born at less than 27 weeks’ gestation in 2006, 77 (13.4%) had severe, and 68 (11.8%) had moderate impairment. Rates for cognitive, communication, and motor impairment were 16%, 11%, and 8%, respectively. An inverse relationship was observed between gestational age and prevalence of moderate or severe impairment, that is, 45% of survivors at 22 to 23 weeks to 30% at 24 weeks, 25% at 25 weeks, and 20% at 26 weeks. Eighty-three children had cerebral palsy, 32 (39%) with diplegia, 21 (25%) with hemiplegia, 10 (12%) with quadriplegia, and 20 (24%) with other types. Nine children (11%) with cerebral palsy had severe sensory impairment; developmental testing showed severe, moderate, or mild impairment in 47 (57%), 30 (46%), and 6 (7%) children, respectively. For births at less than 27 weeks’ gestation in 2006, survival free of moderate or severe impairment ranged from 8% at 23 weeks’ gestation to 59% at 26 weeks’ gestation. Based on babies who received active intervention after birth, rates ranged from 11% at 23 weeks’ gestation to 60% at 26 weeks’ gestation and for babies receiving intensive care from 15% to 61%, respectively. When comparing to the historical cohort, survival to age 3 years for babies admitted to intensive care was 39% in 1995 and 52% in 2006. Overall, the proportion of babies admitted to intensive care who survived with severe disability increased by 2.6%, but a higher proportion survived without disability (11%). Survival without disability increased significantly at 25 and 24 weeks’ gestation (15% and 10%, respectively), but changes were not statistically significant at 23 and 22 weeks’ gestation (2.5% and −0.4%). In 1995, 43 children (18%) had severe disabilities, and 54 (23%) had other disabilities compared with 60 (19%) and 54 (16%), respectively, in 2006. Developmental scores of 55 or less were present in 92% in 1995 and 89% in 2006. Mean scores for these children increased from 84 in 1995 to 91 in 2006. The apparent improvement in survival and disability-free survival is encouraging but tempered by a lack of reduction in the prevalence of severe disability. The results show evidence of improvement in the proportion of babies who survive without disability, an improvement in developmental scores, and a reduction in neurologic morbidity, but no change in rates of severe impairment.