Survie et devenir neurologique à l’âge corrigé de 2 ans des enfants nés extrêmement prématurés

Survival and Impairment of Extremely Premature Infants: A Meta-analysis

CONTEXT

Survival of infants born at the limit of viability varies between high-income countries.

OBJECTIVE

To summarize the prognosis of survival and risk of impairment for infants born at 22 + 0/7 weeks' to 27 + 6/7 weeks' gestational age (GA) in high-income countries.

DATA SOURCES

We searched 9 databases for cohort studies published between 2000 and 2017 in which researchers reported on survival or neurodevelopmental outcomes.

STUDY SELECTION

GA was based on ultrasound results, the last menstrual period, or a combination of both, and neurodevelopmental outcomes were measured by using the Bayley Scales of Infant Development II or III at 18 to 36 months of age.

DATA EXTRACTION

Two reviewers independently extracted data and assessed the risk of bias and quality of evidence.

RESULTS

Sixty-five studies were included. Mean survival rates increased from near 0% of all births, 7.3% of live births, and 24.1% of infants admitted to intensive care at 22 weeks' GA to 82.1%, 90.1%, and 90.2% at 27 weeks' GA, respectively. For the survivors, the rates of severe impairment decreased from 36.3% to 19.1% for 22 to 24 weeks' GA and from 14.0% to 4.2% for 25 to 27 weeks' GA. The mean chance of survival without impairment for infants born alive increased from 1.2% to 9.3% for 22 to 24 weeks' GA and from 40.6% to 64.2% for 25 to 27 weeks' GA.

LIMITATIONS

The confidence in these estimates ranged from high to very low.

CONCLUSIONS

Survival without impairment was substantially lower for children born at <25 weeks' GA than for those born later.

[Trends in neonatal mortality of very-low-birth-weight infants between 1998 and 2013 in Essos Hospital, Yaoundé, Cameroon]

OBJECTIVE

To measure the mortality rate and the survival of very-low-birth-weight (VLBW) infants at two given periods.

METHOD

Descriptive retrospective study. Data were extracted from activity reports and pediatric registries during the years 1998, 1999, and 2004 for the first period and from 2010 to 2013 from the second period. This population study comprised all VLBW infants admitted to the unit weighing <1500g irrespective of gestational age. The main outcome measurement was the percentage of VLBW infants discharged alive during each period.

RESULTS

During the cumulated period, we included a total of 5250 newborn babies, of whom 315 were VLBW, giving a prevalence of 6% (7.1% in period 1 vs 5.5% in period 2, P≤0.05). The overall survival rate of VLNW infants was 52%, corresponding to a mortality rate of 48%. The death rate was 53% during the first period vs 46% in period 2 (P=0.9). In infants weighing between 1000 and 1500g, the mortality rate ranged from 47% in period 1 to 37% in period 2 (P≤0.05). Below 1000g, the rate of survival was consistently below 5%, significantly lower than for infants born above 1000g (P<0.001). In period 2, the caesarian section rate was 7% (20/217), 11% between 1000 and 1500g, 0% below 1000g. The mortality rate was higher with vaginal delivery (47%; 93/196) versus 20% caesarian section (4/20) (OR 3, 61 [1.17-11], P≤0.02).

CONCLUSION

In this center, the hospital mortality rate of VLBW infants seems to have improved, notably in those weighing more than 1000g. Significant efforts are needed to prevent VLBW births and improve management of both delivery and newborn care.

The Association of Urbanicity with Cognitive Development at Five Years of Age in Preterm Children

Objective

To determine the association of urbanicity, defined as living in an urban area, with cognitive development at five years of age in preterm children who were free of any disabilities or neurodevelopmental delays.

Design

Prospective population-based cohort.

Setting

French regional Loire Infant Follow-up Team (LIFT) network.

Participants

Included in the study were 1738 surviving infants born between March 2003 and December 2008 before 35 weeks of gestational age. At two years of age, the children were free of any disabilities and neurodevelopmental delays and were living in the Pays de la Loire region from their birth to five years of age.

Main Outcome Measures

The cognitive development at five years of age was evaluated with the Global School Adaptation score (GSA). The urbanicity of the residence for each child was classified into three groups: urban, quasi-rural, and rural area.

Results

Quantile regression approaches were used to identify a significant association between urbanicity and the GSA score at five years of age (adjusting for child and family characteristics). We found that the negative impact of urbanicity on the GSA score was more important for the lower quantile of the GSA scores.

Conclusions

Urbanicity was significantly associated with cognitive neurodevelopment at five years of age in preterm children born before 35 weeks of gestation. Complementary results additionally suggest that this relation could be mediated at the residence level by a high socioeconomic deprivation level. If these results are confirmed, more personalized follow-ups could be developed for preterm children. Further studies are needed to finely identify the contextual characteristics of urbanicity that underlie this association.

The Global School Adaptation score: a new neurodevelopmental assessment tool for very preterm children at five years of age

OBJECTIVE

To determine the usefulness of a neurodevelopmental assessment tool consisting of a questionnaire administered to teachers to measure the Global School Adaptation (GSA) scores of very preterm children at the age of 5 years.

STUDY DESIGN

A sample of 445 very preterm children (<35 weeks of gestation) was assessed at 5 years of age using GSA and IQ scores. According to the consistency between the scores, children were determined to be well classified, intermediately classified, or misclassified. The differences between groups were assessed through univariate and multivariate logistic regression.

RESULTS

The GSA score was highly or intermediately consistent with the IQ score for 89.2% of the children, and 10.8% were considered misclassified. Children with a higher GSA than IQ score had more autonomy and self-confidence (P < .01), and those with a lower GSA than IQ score had more behavioral problems (P < .01). Analysis by logistic regression showed that sex and gestational age significantly affected the consistency between the 2 scores. Thus, girls were less likely to have a lower GSA than IQ score (aOR = 0.45; 95% CI: 0.24-0.84; P = .01), and a lower gestational age significantly increased the likelihood of having a higher GSA than IQ score (for children born between 24 and 28 weeks of gestation: aOR = 2.70; 95% CI: 1.23-5.92; P = .01).

CONCLUSIONS

The GSA score is a simple, inexpensive, and reliable screening tool for assessing neurodevelopment in very preterm children at 5 years of age.