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Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies)

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7976 (Published 04 December 2012) Cite this as: BMJ 2012;345:e7976
  1. Kate L Costeloe, professor of paediatrics12,
  2. Enid M Hennessy, senior lecturer (statistics)3,
  3. Sadia Haider, research fellow (statistics)3,
  4. Fiona Stacey, research nurse12,
  5. Neil Marlow, professor of neonatal medicine4,
  6. Elizabeth S Draper, professor of perinatal and paediatric epidemiology5
  1. 1Centre For Paediatrics, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  2. 2Homerton University Hospital NHS Foundation Trust, Homerton Row, London
  3. 3Wolfson Institute of Preventive Medicine, Queen Mary University of London, London
  4. 4Academic Neonatology, UCL Institute for Women’s Health, London
  5. 5Department of Health Sciences, University of Leicester, Leicester, UK
  1. Correspondence to: K Costeloe, Neonatal Unit, Homerton University Hospital, London E9 6SR k.l.costeloe{at}qmul.ac.uk
  • Accepted 9 November 2012

Abstract

Objective To determine survival and neonatal morbidity for babies born between 22 and 26 weeks’ gestation in England during 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks’ gestation.

Design Prospective national cohort studies.

Setting Maternity and neonatal units in England.

Participants 3133 births between 22 and 26 weeks’ gestation in 2006; 666 admissions to neonatal units in 1995 and 1115 in 2006 of babies born between 22 and 25 weeks’ gestation.

Main outcome measures Survival to discharge from hospital, pregnancy and delivery outcomes, infant morbidity until discharge.

Results In 2006, survival of live born babies was 2% (n=3) for those born at 22 weeks’ gestation, 19% (n=66) at 23 weeks, 40% (n=178) at 24 weeks, 66% (n=346) at 25 weeks, and 77% (n=448) at 26 weeks (P<0.001). At discharge from hospital, 68% (n=705) of survivors had bronchopulmonary dysplasia (receiving supplemental oxygen at 36 weeks postmenstrual age), 13% (n=135) had evidence of serious abnormality on cerebral ultrasonography, and 16% (n=166) had laser treatment for retinopathy of prematurity. For babies born between 22 and 25 weeks’ gestation from March to December, the number of admissions for neonatal care increased by 44%, from 666 in 1995 to 959 in 2006. By 2006 adherence to evidence based practice associated with improved outcome had significantly increased. Survival increased from 40% to 53% (P<0.001) overall and at each week of gestation: by 9.5% (confidence interval −0.1% to 19%) at 23 weeks, 12% (4% to 20%) at 24 weeks, and 16% (9% to 23%) at 25 weeks. The proportions of babies surviving in 2006 with bronchopulmonary dysplasia, major cerebral scan abnormality, or weight and/or head circumference <−2 SD were similar to those in 1995, but the proportion treated for retinopathy of prematurity had increased from 13% to 22% (P=0.006). Predictors of mortality and morbidity were similar in both cohorts.

Conclusion Survival of babies born between 22 and 25 weeks’ gestation has increased since 1995 but the pattern of major neonatal morbidity and the proportion of survivors affected are unchanged. These observations reflect an important increase in the number of preterm survivors at risk of later health problems.

Footnotes

  • We are grateful for the cooperation of the Confidential Enquiry into Maternal and Child Health (CEMACH); for the help of Kerry Montoute, Elizabeth Rushmer, Rachel Lee, and Catherine Kelly in the EPICure 2 office at Homerton University Hospital NHS Foundation Trust; for database development by Martin Perkins and data entry by Helen Holden at the University of Leicester; and particularly for the staff of contributing hospitals listed in appendix 5. The perinatal component of the EPICure studies was sponsored by Queen Mary, University of London. NM receives part funding from the Department of Health’s NIHR Biomedical Research Centre’s funding scheme at UCLH/UCL.

  • Independent members of EPICure 2 perinatal committee

  • Zarko Alfirevic, Alan Gibson, Shona Golightly, Alison Miller, Michael Webb, Andrew Wilkinson.

  • Independent members of EPICure studies steering committee

  • Peter Brocklehurst (chairman), Jane Abbott, Andrew Bush, Richard Cooke, Noreen Maconochie, Alison Matthews, David Matthews, Richard Morton, Maggie Redshaw, David Taylor, Nigel Turner, Diane Turner, Patrick Walsh.

  • Contributors: KLC and NM developed the hypothesis; KLC and ESD supervised the data collection; FS collected data for both EPICure cohorts and led the validation of EPICure 2 data; KLC, EMH, and SH analysed the data. KLC wrote the first draft and coordinated the production of the manuscript and is guarantor. All authors were involved in the interpretation of the data and writing the report; all have approved the final version.

  • Funding: The study was funded by the Medical Research Council (G0401525). The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study was approved by the East London Research Committee (ref No 05/Q0605/107). Further approval was obtained (PIAG 3-07(f)/2005) to collect data without explicit consent. For surviving infants we sought consent to use the data, maintain contact with the family, and to arrange for long term developmental assessment.

  • Data sharing: The EPICure studies are subject to a data sharing policy that may be downloaded from www.epicure.ac.uk.

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