Mortality and Neurologic, Mental, and Psychomotor Development at 2 Years in Infants Born Less Than 27 Weeks’ Gestation: The Leiden Follow-Up Project on Prematurity
* Departments of Pediatrics
Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
Juliana Children’s Hospital, The Hague, the Netherlands
Objective. To determine the outcome of infants with a gestational age (GA) <27 weeks, born in the mid-1990s.
Design. Regional, prospective study; part of the Leiden Follow-Up Project on Prematurity.
Setting. Three health regions in The Netherlands.
Patients. A total of 266 live born infants (1996/1997) with GA <32 weeks; 46 infants were <27 weeks.
Main outcome measures. Neurologic examination (according to Hempel) and assessment of mental and psychomotor development using the Bayley Scales of Infant Development I, at the corrected age of 2 years.
Results. Mortality was 35% (16 of 46) <27 weeks, compared with 6% (14 of 220) in infants with GA 27 to 32 weeks; withdrawal of treatment in 60% and 43%, respectively. Below 27 weeks mortality was higher after extra-uterine transport and pregnancy induction. Neonatal morbidity was higher in infants <27 weeks compared with infants 27 to 32 weeks. Below 27 weeks postnatal use of dexamethasone and being hospitalized at term were associated with abnormal neurologic outcome; there was a higher incidence in (mild) mental developmental delay compared with the older infants. Adverse outcome (dead or abnormal neurologic, psychomotor, or mental development) in infants 23 to 24, 25, 26, and 27 to 32 weeks GA was, respectively, 92% (11 of 12), 64% (7 of 11), 35% (8 of 23), and 18% (40 of 220).
Conclusions. Mortality and neonatal morbidity were higher in infants with GA <27 weeks compared with infants born between 27 and 32 weeks. The high adverse outcome of infants <25 weeks suggests that one should carefully weigh whether or not to aggressively resuscitate and treat these extremely premature infants.
Key Words: extremely premature infants • mortality • neonatal morbidity • neurologic outcome • psychomotor and mental development • behavior
Abbreviations: GA, gestational age • BPD, bronchopulmonary dysplasia • BSID, Bayley Scales of Infant Development • DA, definitely abnormal • IVH, intraventricular hemorrhage • LFUPP, Leiden Follow-Up Project on Prematurity • MA, mildly abnormal • MDI, mental developmental index • NEC, necrotizing enterocolitis • NICU, neonatal intensive care unit • PDI, psychomotor developmental index • PVL, cystic periventricular leucomalacia • SES, socioeconomic status • OR, odds ratio • CI, confidence interval
Received for publication Jul 15, 2002; Accepted Jan 6, 2003.
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