Abstract:
Background: There is limited recent Irish data describing the survival and neurodevelopmental outcomes of extremely preterm infants delivered at less than or equal to 25 weeks gestation.
The objective is to examine survival and outcome of infants born under 26weeks’ gestation in an Irish tertiary maternity hospital from 2007-2016.
Method: The population is 132 infants born at 23, 24, 25 weeks in CUMH from 2007 to 2016. Ethical approval was granted by the Cork Clinical Research Ethics Committee. Patient details were obtained from the Vermont Oxford and Badger Networks. Survival rates and Bayleys scores were calculated to assess neurodevelopmental outcomes. Statistical analysis with SPSS included frequencies, distributions and comparisons between data from 2007-2011 and 2012-2016.
Results: Overall survival rate was 63%. Of the surviving babies 61% had Bayleys scores calculated. Survival stood at 39% for delivery at 23 weeks, 50% at 24 weeks and 83% at 25 weeks. The 2012 to 2016 cohort has shown further increases in survival with 50% of babies at 23 weeks, 58% of 24 weeks and 89% of 25 weeks. Corresponding figures for 2007-2011 are 20%, 39% and 75%. Gestational age and incidence of periventricular leukomalacia was statistically significant with a p-value of 0.022. Gestational age and delivery room deaths had a p-value of 0.025 as did gestational age and birth weight. Comparison of the 2 cohorts (2007-2011 and 2012-2016) with administration of antenatal steroids showed a statistically significant p-value of 0.044.
Conclusion: There is less morbidity and mortality of the infants born at 25 than at 23 or 24 weeks. Survival of extremely premature infants has increased significantly over the past 10 years. Survival rates with normal neurodevelopmental outcomes are comparable with international standards, and reflect positive changes in attitude and practices in neonatal intensive care. This study will inform parents on the potential outcomes of extreme prematurity and policy regarding management of extreme prematurity.
