Perinatal factors affecting survival and survival without disability of extreme premature infants at two years of age

Ayoubi, J.M; Audibert, F; Boithias, C; Zupan, V; Taylor, S; Bosson, J.L; Frydman, R

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Volume 105, Issue 2 , Pages 124-131, 15 November 2002

Perinatal factors affecting survival and survival without disability of extreme premature infants at two years of age

J.M Ayoubi
- Present address: Département de Gynécologie-Obstétrique, University Hospital, Grenoble France.
F Audibert
C Boithias
- Present address: Service de Réanimation et Pédiatrie Néonatales, University Hospital Antoine Béclère, Assistance Publique, Hôpitaux de Paris, Paris, France.
V Zupan
- Present address: Service de Réanimation et Pédiatrie Néonatales, University Hospital Antoine Béclère, Assistance Publique, Hôpitaux de Paris, Paris, France.
S Taylor
J.L Bosson
- Present address: Service d’Information Médicale, University Hospital, Grenoble, France.
R Frydman
- Corresponding author. Present address: Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92141 Clamart, France. Tel.: +33-1-4537-4768; fax: +33-1-4537-4980.

Département de Gynécologie Obstétrique, University Hospital Antoine Béclère, Assistance Publique, Hôpitaux de Paris, Paris, France

Received 22 June 2001; accepted 18 April 2002.

Abstract

Objective: To study obstetrical factors leading to very preterm delivery (between 24 and 28 weeks) and to relate these factors to neonatal outcome and psychomotor development at two years. Study design: Among 144 infants born alive before 28 weeks of gestation at a single perinatal center between January 1993 and December 1996, we analyzed the influence on neonatal outcome and on psychomotor development at 24 months of a variety of perinatal and neonatal factors. Psychomotor development at two years was classified as: normal, borderline, or moderately or severely handicapped. Results: During the study period, 114 women delivered live infants before 28 weeks’ gestation: 87 singletons, 25 sets of twins, 1 set of triplets and 1 set of quadruplets. All 144 live-born infants received neonatal resuscitation: 50 died before discharge. At two years of age, 6 of the 94 survivors were lost to follow-up. Assessments of the psychomotor development of the other 88 was normal for 52%; borderline for 20%, moderately handicapped for 20%, and severely handicapped for 8%. Multivariate analysis found that two factors affected survival: birthweight and fetal heart rate. (The 42% of infants with a birthweight below 700g survived versus 83% above 900g, P<0.001, OR=5.2, 95% CI (confidence interval) [2.4–11.2].) Conclusion: These data show the influence of perinatal factors on the outcome of very preterm infants; birthweight and fetal heart rate are strongly correlated with survival. Gestational age is a good predictor of psychomotor development at two years.