[Morbidity and mortality of extremely low gestational age infants in Schleswig-Holstein. Follow-up at three to six years corrected age of infants < 27 + 0 weeks gestation in Schleswig-Holstein, Germany].

BACKGROUND

Regional, population-based outcome studies of extremely preterm infants may help to assess the quality of neonatal care across centres and explain variation.

PATIENTS AND METHODS

We included all extremely low gestational age infants (< 27 + 0 gestational age = ELGA) of six paediatric hospitals in Schleswig-Holstein born during 1997 to 1999. The surviving children were evaluated at the corrected age of three to six years with the developmental test ET 6-6. The end point major disability was determined as subnormal scores in the developmental test ET 6-6 (< 2 SD), or any of the following diagnoses: cerebral palsy, blindness, deafness, epilepsy and/or hydrocephalus requiring a shunt system.

RESULTS

130 infants with gestational age (GA) < 27 + 0 weeks were identified. 85 survived until discharge and 82 survived until follow-up. 63 children (77% of all possible cases) participated in the developmental test. Neonatal survival increased with gestational age: 0/1 GA = 22 weeks, 3/10 GA = 23 weeks, 12/25 GA 24 = weeks, 28/43 GA = 25 weeks, 42/51 GA = 26 weeks. At follow-up 24 children had a major disability, among those were 14 children with multiple major disabilities. There was no significant correlation between major disability and gestational age.

CONCLUSIONS

In a regional neonatal care system only infants of 25 to 26 weeks gestation but not those of lower GA show good survival rates. Major disability of extremely preterm infants seems to be independent of gestational age.