Pierre-Yves Ancel1, François Goffinet2, Pierre Kuhn3, Bruno Langer3, Jacqueline Matis3, Xavier Hernandorena4, Pierre Chabanier5, Laurence Joly-Pedespan5, Bénédicte Lecomte6, Françoise Vendittelli6, Michel Dreyfus7, Bernard Guillois8, Antoine Burguet9, Pierre Sagot10, Jacques Sizun11, Alain Beuchée12, Florence Rouget12, Amélie Favreau13, Elie Saliba14, Nathalie Bednarek15, Patrice Morville15, Gérard Thiriez16, Loïc Marpeau17, Stéphane Marret18, Gilles Kayem19, Xavier Durrmeyer20, Michèle Granier21, Olivier Baud22, Pierre-Henri Jarreau23, Delphine Mitanchez24, Pascal Boileau25, Pierre Boulot26, Gilles Cambonie27, Hubert Daudé28, Antoine Bédu29, Fabienne Mons29, Jeanne Fresson30, Rachel Vieux31, Corine Alberge, Catherine Alberge32, Catherine Arnaud32, Christophe Vayssière33, Patrick Truffert34, Véronique Pierrat34, Damien Subtil35, Claude D'Ercole36, Catherine Gire37, Umberto Simeoni38, André Bongain39, Loïc Sentilhes40, Jean-Christophe Rozé41, Jean Gondry42, André Leke43, Michel Deiber44, Olivier Claris45, Jean-Charles Picaud46, Anne Ego47, Thierry Debillon48, Anne Poulichet49, Eliane Coliné49, Anne Favre50, Olivier Fléchelles51, Sylvain Samperiz52, Duksha Ramful52, Bernard Branger53, Valérie Benhammou54, Laurence Foix-L'Hélias54, Laetitia Marchand-Martin54, Monique Kaminski54. 1. Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France2Paris Descartes University, Paris, France3Clinical Research Unit, Center for Clinical Investigation. 2. Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France2Paris Descartes University, Paris, France4Maternité Port-Royal, Hospital University Department Risks. 3. University Hospital, Strasbourg, France. 4. La Côte Basque Hospital, Bayonne, France. 5. University Hospital, Bordeaux, France. 6. University Hospital Estaing, Clermont-Ferrand, France. 7. Department of Gynecology and Obstetrics, University Hospital, Caen, France. 8. Department of Neonatal Pediatrics and Intensive Care, University Hospital, Caen, France. 9. Department of Neonatal Pediatrics, University Hospital, Dijon, France. 10. Department of Gynecology and Obstetrics, University Hospital, Dijon, France. 11. University Hospital, Brest, France. 12. Department of Pediatrics, University Hospital, Inserm-Irset U 1085, Rennes, France. 13. Department of Neonatal Pediatrics and Intensive Care, University Hospital, Tours, France. 14. INSERM U 930, François Rabelais University, Tours, France. 15. Department of Neonatal Pediatrics, University Hospital, Reims, France. 16. Department of Neonatal Pediatrics, University Hospital, Besançon, France. 17. Department of Gynecology and Obstetrics, University Hospital, Rouen, France. 18. Department of Neonatal Pediatrics and Intensive Care, Rouen University Hospital-Laboratory of microvascular endothelium and neonatal brain lesions, Rouen, France. 19. Department of Obstetrics and Gynecology, Louis Mourier Hospital, University Hospitals Paris Nord Val de Seine (HUPNVS)), Assistance Publique-Paris Hospitals (APHP), Paris Diderot University, Paris, France. 20. Department of Neonatal Pediatrics and Intensive Care, CHI, CRC, Créteil, France. 21. Department of Neonatal Pediatrics, Sud Francilien Hospital, Evry, France. 22. Neonatal intensive care unit, Robert Debré Hospital, INSERM, UMR 676, Paris, France. 23. Department of Neonatal Pediatrics and Intensive Care, Cochin Hotel Dieu Hospital, Paris, France. 24. Department of Neonatal Pediatrics, Trousseau Hospital, Paris, France. 25. Department of Neonatal Pediatrics, Poissy Saint Germain University Hospital, Poissy, France. 26. Department of Obstetrics and Gynecology, Arnaud de Villeneuve Hospital, Montpellier, France. 27. Department of Neonatal Pediatrics and Intensive Care, Arnaud de Villeneuve Hospital, Montpellier, France. 28. CAMSP, University Hospital, Montpellier, France. 29. Department of Neonatal Pediatrics, Mère-Enfant Hospital, Limoges, France. 30. Department of Medical Information, Adolphe Pinard Maternity Unit, Nancy, France. 31. Department of Neonatal Pediatrics and Intensive Care, Adolphe Pinard Maternity Unit, Nancy, France. 32. UMR 1027 INSERM, Paul-Sabatier Toulouse III University, Toulouse, France. 33. Department of Obstetrics and Gynecology, Toulouse, France. 34. Department of Neonatal Pediatrics, Jeanne de Flandres Hospital, Lille, France. 35. Department of Gynecology and Obstetrics, Jeanne de Flandre Hospital, Lille, France. 36. Department of Gynecology and Obstetrics, Nord Hospital, Marseille, France. 37. Department of Neonatal Pediatrics and Intensive Care, Nord Hospital, Marseille, France. 38. Department of Neonatal Pediatrics and Intensive Care, La Conception Hospital, Marseille, France. 39. Department of Gynecology and Obstetrics, Archet Hospital, Nice, France. 40. Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France. 41. Department of Neonatal Medicine, Angers University Hospital and INSERM CIC 004, Nantes, France. 42. Department of Obstetrics and gynecology, Amiens, France. 43. Department of Pediatrics, Amiens, France. 44. Department of Pediatrics, Chambéry, France. 45. Department of Neonatal Pediatrics and Intensive Care, University Hospital, Lyon, France. 46. Department of Neonatal Pediatrics and Intensive Care, La Croix Rousse Hospital, Lyon, France. 47. INSERM CIC003, University Hospital, Grenoble, France. 48. Department of Neonatal Pediatrics, University Hospital, Grenoble, France. 49. University Hospital, Pointe à Pitre, Guadeloupe, France. 50. Department of Neonatal Pediatrics and Intensive Care, Cayenne Hospital, Cayenne, Guyane, France. 51. University Hospital, Fort de France, Martinique. 52. Department of Neonatal Pediatrics and Intensive Care, University Hospital Felix Guyon, Saint-Denis, La Réunion, France. 53. Fédération des Réseaux de Santé en Périnatalité [FFRSP], Nantes, France. 54. Inserm UMR1153, Perinatal and Pediatric Epidemiology Team, Paris, France.
Abstract
IMPORTANCE: Up-to-date estimates of the health outcomes of preterm children are needed for assessing perinatal care, informing parents, making decisions about care, and providing evidence for clinical guidelines. OBJECTIVES: To determine survival and neonatal morbidity of infants born from 22 through 34 completed weeks' gestation in France in 2011 and compare these outcomes with a comparable cohort in 1997. DESIGN, SETTING, AND PARTICIPANTS: The EPIPAGE-2 study is a national, prospective, population-based cohort study conducted in all maternity and neonatal units in France in 2011. A total of 2205 births (stillbirths and live births) and terminations of pregnancy at 22 through 26 weeks' gestation, 3257 at 27 through 31 weeks, and 1234 at 32 through 34 weeks were studied. Cohort data were collected from January 1 through December 31, 1997, and from March 28 through December 31, 2011. Analyses for 1997 were run for the entire year and then separately for April to December; the rates for survival and morbidities did not differ. Data are therefore presented for the whole year in 1997 and the 8-month and 6-month periods in 2011. MAIN OUTCOMES AND MEASURES: Survival to discharge and survival without any of the following adverse outcomes: grade III or IV intraventricular hemorrhage, cystic periventricular leukomalacia, severe bronchopulmonary dysplasia, retinopathy of prematurity (stage 3 or higher), or necrotizing enterocolitis (stages 2-3). RESULTS: A total of 0.7% of infants born before 24 weeks' gestation survived to discharge: 31.2% of those born at 24 weeks, 59.1% at 25 weeks, and 75.3% at 26 weeks. Survival rates were 93.6% at 27 through 31 weeks and 98.9% at 32 through 34 weeks. Infants discharged home without severe neonatal morbidity represented 0% at 23 weeks, 11.6% at 24 weeks, 30.0% at 25 weeks, 47.5% at 26 weeks, 81.3% at 27 through 31 weeks, and 96.8% at 32 through 34 weeks. Compared with 1997, the proportion of infants surviving without severe morbidity in 2011 increased by 14.4% (P < .001) at 25 through 29 weeks and 6% (P < .001) at 30 through 31 weeks but did not change appreciably for those born at less than 25 weeks. The rates of antenatal corticosteroid use, induced preterm deliveries, cesarean deliveries, and surfactant use increased significantly in all gestational-age groups, except at 22 through 23 weeks. CONCLUSIONS AND RELEVANCE: The substantial improvement in survival in France for newborns born at 25 through 31 weeks' gestation was accompanied by an important reduction in severe morbidity, but survival remained rare before 25 weeks. Although improvement in survival at extremely low gestational age may be possible, its effect on long-term outcomes requires further studies. The long-term results of the EPIPAGE-2 study will be informative in this regard.
IMPORTANCE: Up-to-date estimates of the health outcomes of preterm children are needed for assessing perinatal care, informing parents, making decisions about care, and providing evidence for clinical guidelines. OBJECTIVES: To determine survival and neonatal morbidity of infants born from 22 through 34 completed weeks' gestation in France in 2011 and compare these outcomes with a comparable cohort in 1997. DESIGN, SETTING, AND PARTICIPANTS: The EPIPAGE-2 study is a national, prospective, population-based cohort study conducted in all maternity and neonatal units in France in 2011. A total of 2205 births (stillbirths and live births) and terminations of pregnancy at 22 through 26 weeks' gestation, 3257 at 27 through 31 weeks, and 1234 at 32 through 34 weeks were studied. Cohort data were collected from January 1 through December 31, 1997, and from March 28 through December 31, 2011. Analyses for 1997 were run for the entire year and then separately for April to December; the rates for survival and morbidities did not differ. Data are therefore presented for the whole year in 1997 and the 8-month and 6-month periods in 2011. MAIN OUTCOMES AND MEASURES: Survival to discharge and survival without any of the following adverse outcomes: grade III or IV intraventricular hemorrhage, cystic periventricular leukomalacia, severe bronchopulmonary dysplasia, retinopathy of prematurity (stage 3 or higher), or necrotizing enterocolitis (stages 2-3). RESULTS: A total of 0.7% of infants born before 24 weeks' gestation survived to discharge: 31.2% of those born at 24 weeks, 59.1% at 25 weeks, and 75.3% at 26 weeks. Survival rates were 93.6% at 27 through 31 weeks and 98.9% at 32 through 34 weeks. Infants discharged home without severe neonatal morbidity represented 0% at 23 weeks, 11.6% at 24 weeks, 30.0% at 25 weeks, 47.5% at 26 weeks, 81.3% at 27 through 31 weeks, and 96.8% at 32 through 34 weeks. Compared with 1997, the proportion of infants surviving without severe morbidity in 2011 increased by 14.4% (P < .001) at 25 through 29 weeks and 6% (P < .001) at 30 through 31 weeks but did not change appreciably for those born at less than 25 weeks. The rates of antenatal corticosteroid use, induced preterm deliveries, cesarean deliveries, and surfactant use increased significantly in all gestational-age groups, except at 22 through 23 weeks. CONCLUSIONS AND RELEVANCE: The substantial improvement in survival in France for newborns born at 25 through 31 weeks' gestation was accompanied by an important reduction in severe morbidity, but survival remained rare before 25 weeks. Although improvement in survival at extremely low gestational age may be possible, its effect on long-term outcomes requires further studies. The long-term results of the EPIPAGE-2 study will be informative in this regard.
Authors: Matthew A Rysavy; Lei Li; Edward F Bell; Abhik Das; Susan R Hintz; Barbara J Stoll; Betty R Vohr; Waldemar A Carlo; Seetha Shankaran; Michele C Walsh; Jon E Tyson; C Michael Cotten; P Brian Smith; Jeffrey C Murray; Tarah T Colaizy; Jane E Brumbaugh; Rosemary D Higgins Journal: N Engl J Med Date: 2015-05-07 Impact factor: 91.245
Authors: Christine Henriksen; Astrid N Almaas; Ane C Westerberg; Christian A Drevon; Per O Iversen; Britt Nakstad Journal: Eur J Pediatr Date: 2016-08-09 Impact factor: 3.183