Intensity of perinatal care for extreme preterm births and neurodevelopmental outcomes at age 5½: the EPIPAGE-2 cohort study.

Abstract

Objective: To explore the impact of intensity of perinatal ('survival-focused') care on outcomes at 5½ years for two groups of survivors: those born at 24-26 and at 27-28 weeks of gestation.

Design: Prospective, population-based national cohort.

Setting: France, 2011.

Patients: Children surviving to 5½ years who were born at <29 weeks gestation.

Interventions: Intensity of perinatal care, defined at the hospital level, categorised into three based on the ratio of babies of 24-25 weeks of gestation admitted into neonatal intensive care to the number of fetuses alive at maternal admission to hospital subsequently delivered at 24-25 weeks gestation.

Main outcome measures: Neurodevelopmental disability (NDD-none, mild, moderate or severe) comprising cognitive, behavioural, sensory and motor abilities.

Results: Among 3217 births, 472 children born at 24-26 weeks and 633 born at 27-28 weeks survived. At 24-26 weeks, compared with children born in low-intensity hospitals, children born in high-intensity hospitals had the lowest levels of mild (33.9%) and moderate-severe (21.9%) NDD (ORs 0.42, 0.20-0.88 and 0.47, 0.20-1.12, respectively); no difference was found between hospitals of low and medium intensity. At 27-28 weeks of gestation, no differences were seen between hospitals of any intensity level (p=0.75).

Conclusions: No evidence was found to support concerns that survival-focused perinatal care is associated with increased long-term NDDs in children born extremely preterm or at a higher gestational age.