Changes in long-term prognosis with increasing postnatal survival and the occurrence of postnatal morbidities in extremely preterm infants offered intensive care: a prospective observational study

Jeanie L.Y. Cheong, Katherine J. Lee, Rosemarie A. Boland, Alicia J. Spittle, Gillian F. Opie, Alice C. Burnett, Leah Hickey, Gehan Roberts, Peter J. Anderson, Lex W. Doyle, Victorian Infant Collaborative Study Group

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Decisions regarding provision of intensive care and post-discharge follow-up for infants born extremely preterm (<28 weeks' gestation) are based on the risks of mortality and neurodevelopmental disability. We aimed to elucidate the changes in probability of three outcomes (death, survival with major disability, and survival without major disability) with postnatal age in extremely preterm infants offered intensive care, and the effect of postnatal events on the probability of survival without major disability. Methods: In this prospective observational study, we used data from three geographical cohorts composed of all extremely preterm livebirths offered intensive care at birth during three distinct periods (1991–92, 1997, and 2005) in Victoria, Australia. Participants were assessed at 8 years' corrected age for major neurodevelopmental disability, defined as moderate or severe cerebral palsy, general intelligence more than 2 SDs below term-born control means, blindness, or deafness. Probabilities of outcomes conditional on survival to different postnatal ages were calculated by logistic regression. Multivariable logistic regression was used to assess factors predictive of survival with major disability. Findings: 751 (82%) of 915 extremely preterm livebirths free of lethal anomalies were offered intensive care, of whom 546 (73%) survived to age 8 years. Of the 499 survivors assessed, 86 (17%) had a major disability. With increasing gestational age at birth or days of postnatal survival, the probability of death decreased and of survival without major disability increased. By contrast, the probability of survival with major disability varied little with gestational age or postnatal survival. In survivors, major disability was associated with the occurrence of four important postnatal events: grade 3 or 4 intraventricular haemorrhage (odds ratio 2·61 [95% CI 1·11–6·15]), cystic periventricular leukomalacia (9·17 [3·57–23·53]), postnatal corticosteroid use (1·99 [1·03–3·85]), and surgery (2·78 [1·51–5·13]). 241 survivors (48%) had no major postnatal events during the newborn period, and had the lowest prevalence of major disability (17 participants [7%]). The probability of survival without major disability decreased with increasing number of major events (0·93 [0·89–0·96] for no events vs 0·31 [0·11–0·59] for three or more events). Interpretation: Long-term prognosis in terms of death and major neurodevelopmental disability changes rapidly after birth for extremely preterm infants. Counselling of families and post-discharge planning should be individualised to changing circumstances following birth. Funding: National Health and Medical Research Council of Australia.

Original languageEnglish
Pages (from-to)872-879
Number of pages8
JournalThe Lancet Child and Adolescent Health
Volume2
Issue number12
DOIs
Publication statusPublished - 1 Dec 2018

Cite this

Cheong, Jeanie L.Y. ; Lee, Katherine J. ; Boland, Rosemarie A. ; Spittle, Alicia J. ; Opie, Gillian F. ; Burnett, Alice C. ; Hickey, Leah ; Roberts, Gehan ; Anderson, Peter J. ; Doyle, Lex W. ; Victorian Infant Collaborative Study Group. / Changes in long-term prognosis with increasing postnatal survival and the occurrence of postnatal morbidities in extremely preterm infants offered intensive care : a prospective observational study. In: The Lancet Child and Adolescent Health. 2018 ; Vol. 2, No. 12. pp. 872-879.
@article{45bde4967dff469faec0a459fad71050,
title = "Changes in long-term prognosis with increasing postnatal survival and the occurrence of postnatal morbidities in extremely preterm infants offered intensive care: a prospective observational study",
abstract = "Background: Decisions regarding provision of intensive care and post-discharge follow-up for infants born extremely preterm (<28 weeks' gestation) are based on the risks of mortality and neurodevelopmental disability. We aimed to elucidate the changes in probability of three outcomes (death, survival with major disability, and survival without major disability) with postnatal age in extremely preterm infants offered intensive care, and the effect of postnatal events on the probability of survival without major disability. Methods: In this prospective observational study, we used data from three geographical cohorts composed of all extremely preterm livebirths offered intensive care at birth during three distinct periods (1991–92, 1997, and 2005) in Victoria, Australia. Participants were assessed at 8 years' corrected age for major neurodevelopmental disability, defined as moderate or severe cerebral palsy, general intelligence more than 2 SDs below term-born control means, blindness, or deafness. Probabilities of outcomes conditional on survival to different postnatal ages were calculated by logistic regression. Multivariable logistic regression was used to assess factors predictive of survival with major disability. Findings: 751 (82{\%}) of 915 extremely preterm livebirths free of lethal anomalies were offered intensive care, of whom 546 (73{\%}) survived to age 8 years. Of the 499 survivors assessed, 86 (17{\%}) had a major disability. With increasing gestational age at birth or days of postnatal survival, the probability of death decreased and of survival without major disability increased. By contrast, the probability of survival with major disability varied little with gestational age or postnatal survival. In survivors, major disability was associated with the occurrence of four important postnatal events: grade 3 or 4 intraventricular haemorrhage (odds ratio 2·61 [95{\%} CI 1·11–6·15]), cystic periventricular leukomalacia (9·17 [3·57–23·53]), postnatal corticosteroid use (1·99 [1·03–3·85]), and surgery (2·78 [1·51–5·13]). 241 survivors (48{\%}) had no major postnatal events during the newborn period, and had the lowest prevalence of major disability (17 participants [7{\%}]). The probability of survival without major disability decreased with increasing number of major events (0·93 [0·89–0·96] for no events vs 0·31 [0·11–0·59] for three or more events). Interpretation: Long-term prognosis in terms of death and major neurodevelopmental disability changes rapidly after birth for extremely preterm infants. Counselling of families and post-discharge planning should be individualised to changing circumstances following birth. Funding: National Health and Medical Research Council of Australia.",
author = "Cheong, {Jeanie L.Y.} and Lee, {Katherine J.} and Boland, {Rosemarie A.} and Spittle, {Alicia J.} and Opie, {Gillian F.} and Burnett, {Alice C.} and Leah Hickey and Gehan Roberts and Anderson, {Peter J.} and Doyle, {Lex W.} and {Victorian Infant Collaborative Study Group}",
year = "2018",
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doi = "10.1016/S2352-4642(18)30287-6",
language = "English",
volume = "2",
pages = "872--879",
journal = "The Lancet Child and Adolescent Health",
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Changes in long-term prognosis with increasing postnatal survival and the occurrence of postnatal morbidities in extremely preterm infants offered intensive care : a prospective observational study. / Cheong, Jeanie L.Y.; Lee, Katherine J.; Boland, Rosemarie A.; Spittle, Alicia J.; Opie, Gillian F.; Burnett, Alice C.; Hickey, Leah; Roberts, Gehan; Anderson, Peter J.; Doyle, Lex W.; Victorian Infant Collaborative Study Group.

In: The Lancet Child and Adolescent Health, Vol. 2, No. 12, 01.12.2018, p. 872-879.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Changes in long-term prognosis with increasing postnatal survival and the occurrence of postnatal morbidities in extremely preterm infants offered intensive care

T2 - a prospective observational study

AU - Cheong, Jeanie L.Y.

AU - Lee, Katherine J.

AU - Boland, Rosemarie A.

AU - Spittle, Alicia J.

AU - Opie, Gillian F.

AU - Burnett, Alice C.

AU - Hickey, Leah

AU - Roberts, Gehan

AU - Anderson, Peter J.

AU - Doyle, Lex W.

AU - Victorian Infant Collaborative Study Group

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: Decisions regarding provision of intensive care and post-discharge follow-up for infants born extremely preterm (<28 weeks' gestation) are based on the risks of mortality and neurodevelopmental disability. We aimed to elucidate the changes in probability of three outcomes (death, survival with major disability, and survival without major disability) with postnatal age in extremely preterm infants offered intensive care, and the effect of postnatal events on the probability of survival without major disability. Methods: In this prospective observational study, we used data from three geographical cohorts composed of all extremely preterm livebirths offered intensive care at birth during three distinct periods (1991–92, 1997, and 2005) in Victoria, Australia. Participants were assessed at 8 years' corrected age for major neurodevelopmental disability, defined as moderate or severe cerebral palsy, general intelligence more than 2 SDs below term-born control means, blindness, or deafness. Probabilities of outcomes conditional on survival to different postnatal ages were calculated by logistic regression. Multivariable logistic regression was used to assess factors predictive of survival with major disability. Findings: 751 (82%) of 915 extremely preterm livebirths free of lethal anomalies were offered intensive care, of whom 546 (73%) survived to age 8 years. Of the 499 survivors assessed, 86 (17%) had a major disability. With increasing gestational age at birth or days of postnatal survival, the probability of death decreased and of survival without major disability increased. By contrast, the probability of survival with major disability varied little with gestational age or postnatal survival. In survivors, major disability was associated with the occurrence of four important postnatal events: grade 3 or 4 intraventricular haemorrhage (odds ratio 2·61 [95% CI 1·11–6·15]), cystic periventricular leukomalacia (9·17 [3·57–23·53]), postnatal corticosteroid use (1·99 [1·03–3·85]), and surgery (2·78 [1·51–5·13]). 241 survivors (48%) had no major postnatal events during the newborn period, and had the lowest prevalence of major disability (17 participants [7%]). The probability of survival without major disability decreased with increasing number of major events (0·93 [0·89–0·96] for no events vs 0·31 [0·11–0·59] for three or more events). Interpretation: Long-term prognosis in terms of death and major neurodevelopmental disability changes rapidly after birth for extremely preterm infants. Counselling of families and post-discharge planning should be individualised to changing circumstances following birth. Funding: National Health and Medical Research Council of Australia.

AB - Background: Decisions regarding provision of intensive care and post-discharge follow-up for infants born extremely preterm (<28 weeks' gestation) are based on the risks of mortality and neurodevelopmental disability. We aimed to elucidate the changes in probability of three outcomes (death, survival with major disability, and survival without major disability) with postnatal age in extremely preterm infants offered intensive care, and the effect of postnatal events on the probability of survival without major disability. Methods: In this prospective observational study, we used data from three geographical cohorts composed of all extremely preterm livebirths offered intensive care at birth during three distinct periods (1991–92, 1997, and 2005) in Victoria, Australia. Participants were assessed at 8 years' corrected age for major neurodevelopmental disability, defined as moderate or severe cerebral palsy, general intelligence more than 2 SDs below term-born control means, blindness, or deafness. Probabilities of outcomes conditional on survival to different postnatal ages were calculated by logistic regression. Multivariable logistic regression was used to assess factors predictive of survival with major disability. Findings: 751 (82%) of 915 extremely preterm livebirths free of lethal anomalies were offered intensive care, of whom 546 (73%) survived to age 8 years. Of the 499 survivors assessed, 86 (17%) had a major disability. With increasing gestational age at birth or days of postnatal survival, the probability of death decreased and of survival without major disability increased. By contrast, the probability of survival with major disability varied little with gestational age or postnatal survival. In survivors, major disability was associated with the occurrence of four important postnatal events: grade 3 or 4 intraventricular haemorrhage (odds ratio 2·61 [95% CI 1·11–6·15]), cystic periventricular leukomalacia (9·17 [3·57–23·53]), postnatal corticosteroid use (1·99 [1·03–3·85]), and surgery (2·78 [1·51–5·13]). 241 survivors (48%) had no major postnatal events during the newborn period, and had the lowest prevalence of major disability (17 participants [7%]). The probability of survival without major disability decreased with increasing number of major events (0·93 [0·89–0·96] for no events vs 0·31 [0·11–0·59] for three or more events). Interpretation: Long-term prognosis in terms of death and major neurodevelopmental disability changes rapidly after birth for extremely preterm infants. Counselling of families and post-discharge planning should be individualised to changing circumstances following birth. Funding: National Health and Medical Research Council of Australia.

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DO - 10.1016/S2352-4642(18)30287-6

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JO - The Lancet Child and Adolescent Health

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