Encouraging news for prognosis of extremely premature babies
Parents of extremely preterm infants may gain reassurance from a new study showing dramatic day-by-day improvements in long-term prognosis for those receiving intensive care.
The study in The Lancet Child and Adolescent Health followed up 715 children born at less than 28 weeks gestation who were offered intensive care in Victorian hospitals during three distinct periods (1991-92, 1997 and 2005).
Almost three-quarters of the children (73%) offered intensive care survived to age 8 years, and 83% of the survivors were free of major disabilities (moderate-to-severe cerebral palsy, blindness, deafness, or profound cognitive disability).
A major finding of the study was that an extremely premature baby’s risk of death and major disability rapidly declined in the first few days after birth, such that by the time of their discharge home their risk of death was similar to healthy full-term babies’.
Lead study author, Associate Professor Jeanie Cheong from the Royal Women’s Hospital in Melbourne commented: “This is very encouraging news for parents who are often very frightened when taking their newborn baby home from hospital.”
The study also confirmed four sentinel events in the postnatal period that strongly increased the likelihood of major disability: grade 3 or 4 intraventricular haemorrhage or cystic periventricular leukomalacia (both indicating brain damage), postnatal corticosteroid use to treat or prevent lung injury and surgery in the newborn period.
Almost one-half (48%) of the extremely preterm babies avoided all of these complications, and of those that did avoid these events, 93% survived without major disability.
Parents deserve regular updates
The study authors said the rapid changes in prognosis in the first few days after birth should be acknowledged by clinicians and conveyed to families.
“As survival prospects change rapidly immediately after birth, ongoing counselling should be provided… If one of the four major events arises, advice should be updated,” they wrote.
Professor Cheong said the study’s findings demonstrated how each baby’s individual risk changed significantly over the course of their intensive care treatment.
“Parents may be taking home their baby fearing that they are at a much higher risk of death or long-term disability than is the reality,” she said. “Now we can tailor the risk information to bring much-needed reassurance to parents.”
Preventing preterm births
The mean gestational age at birth in the study was 25.6 weeks and mean birth weight was 835g. Three survivors died between discharge and 2 years of age, but no additional deaths occurred between 2 years and 8 years of age.
Mortality by age 8 years was lower in infants who were given antenatal corticosteroids than in those who were not (OR 0.61, SD 1.2 and CI 0.39-0.97, p=0.37) and decreased with increasing gestational age at birth (0.58 for every 1 week increase). For babies born at 23 weeks, the chance of survival was around 45% for those offered intensive care.
Only seven (8%) of live births at 22 weeks gestation were offered intensive care, and only two of these children survived.
There was little difference in survival with major disability between birth eras.
Professor Cheong told doctorportal: “The ultimate goal would of course be to prevent preterm birth, and there are a lot of efforts happening in that space.”
“The reality is, however, that extremely preterm babies will continue to be born and we have the responsibility to parents and the children themselves, to inform them of the risks associated with death and major disability.”