Pierrat Véronique, Marchand-Martin Laetitia, Arnaud Catherine, Kaminski Monique, Resche-Rigon Matthieu, Lebeaux Cécile, Bodeau-Livinec Florence, Morgan Andrei S, Goffinet François, Marret Stéphane, Ancel Pierre-Yves
Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France; Paris Descartes University, Paris, France
CHU Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, F-59000 Lille, France.
BMJ. 2017 Aug 16;358:j3448. doi: 10.1136/bmj.j3448.
To describe neurodevelopmental outcomes at 2 years corrected age for children born alive at 22-26, 27-31, and 32-34 weeks' gestation in 2011, and to evaluate changes since 1997. Population based cohort studies, EPIPAGE and EPIPAGE-2. France. 5567 neonates born alive in 2011 at 22-34 completed weeks' gestation, with 4199 survivors at 2 years corrected age included in follow-up. Comparison of outcomes reported for 3334 (1997) and 2418 (2011) neonates born alive in the nine regions participating in both studies. Survival; cerebral palsy (2000 European consensus definition); scores below threshold on the neurodevelopmental Ages and Stages Questionnaire (ASQ; at least one of five domains below threshold) if completed between 22 and 26 months corrected age, in children without cerebral palsy, blindness, or deafness; and survival without severe or moderate neuromotor or sensory disabilities (cerebral palsy with Gross Motor Function Classification System levels 2-5, unilateral or bilateral blindness or deafness). Results are given as percentage of outcome measures with 95% confidence intervals. Among 5170 liveborn neonates with parental consent, survival at 2 years corrected age was 51.7% (95% confidence interval 48.6% to 54.7%) at 22-26 weeks' gestation, 93.1% (92.1% to 94.0%) at 27-31 weeks' gestation, and 98.6% (97.8% to 99.2%) at 32-34 weeks' gestation. Only one infant born at 22-23 weeks survived. Data on cerebral palsy were available for 3599 infants (81.0% of the eligible population). The overall rate of cerebral palsy at 24-26, 27-31, and 32-34 weeks' gestation was 6.9% (4.7% to 9.6%), 4.3% (3.5% to 5.2%), and 1.0% (0.5% to 1.9%), respectively. Responses to the ASQ were analysed for 2506 children (56.4% of the eligible population). The proportion of children with an ASQ result below threshold at 24-26, 27-31, and 32-34 weeks' gestation were 50.2% (44.5% to 55.8%), 40.7% (38.3% to 43.2%), and 36.2% (32.4% to 40.1%), respectively. Survival without severe or moderate neuromotor or sensory disabilities among live births increased between 1997 and 2011, from 45.5% (39.2% to 51.8%) to 62.3% (57.1% to 67.5%) at 25-26 weeks' gestation, but no change was observed at 22-24 weeks' gestation. At 32-34 weeks' gestation, there was a non-statistically significant increase in survival without severe or moderate neuromotor or sensory disabilities (P=0.61), but the proportion of survivors with cerebral palsy declined (P=0.01). In this large cohort of preterm infants, rates of survival and survival without severe or moderate neuromotor or sensory disabilities have increased during the past two decades, but these children remain at high risk of developmental delay.
描述2011年妊娠22 - 26周、27 - 31周和32 - 34周出生并存活的儿童在矫正年龄2岁时的神经发育结局，并评估自1997年以来的变化。基于人群的队列研究，EPIPAGE和EPIPAGE - 2。法国。2011年5567例妊娠22 - 34周出生并存活的新生儿，4199例矫正年龄2岁的存活者纳入随访。对参与两项研究的9个地区1997年出生并存活的3334例新生儿和2011年出生并存活的2418例新生儿的结局报告进行比较。生存情况；脑瘫（2000年欧洲共识定义）；在矫正年龄22至26个月之间完成神经发育年龄与阶段问卷（ASQ；五个领域中至少一个领域低于阈值）且无脑瘫、失明或失聪的儿童；以及无严重或中度神经运动或感觉障碍（粗大运动功能分类系统2 - 5级的脑瘫、单侧或双侧失明或失聪）的生存情况。结果以结局指标的百分比及95%置信区间表示。在5170例获得父母同意的活产新生儿中，妊娠22 - 26周矫正年龄2岁时的生存率为51.7%（95%置信区间48.6%至54.7%），妊娠27 - 31周时为93.1%（92.1%至94.0%），妊娠32 - 34周时为98.6%（97.8%至99.2%）。仅1例妊娠22 - 23周出生的婴儿存活。3599例婴儿（符合条件人群的81.0%）有脑瘫数据。妊娠24 - 26周、27 - 31周和32 - 34周时脑瘫的总体发生率分别为6.9%（4.7%至9.6%）、4.3%（3.5%至5.2%）和1.0%（0.5%至1.9%）。对2506例儿童（符合条件人群的56.4%）的ASQ回答进行了分析。妊娠24 - 26周、27 - 31周和32 - 34周时ASQ结果低于阈值的儿童比例分别为50.2%（44.5%至55.8%）、40.7%（38.3%至43.2%）和36.2%（32.
