4.5 Article

Mortality and significant neurosensory impairment in preterm infants: an international comparison

出版社

BMJ PUBLISHING GROUP
DOI: 10.1136/archdischild-2021-322288

关键词

neonatology; neurology

资金

  1. French Institute of Public Health Research/Institute of Public Health
  2. French Health Ministry
  3. National Institute of Health and Medical Research (INSERM)
  4. National Institute of Cancer
  5. National Solidarity Fund for Autonomy (CNSA)
  6. National Research Agency through the French EQUIPEX program of investments in the future [ANR-11-EQPX-0038]
  7. PREMUP Foundation
  8. Fondation de France [00050329]
  9. Fondation pour la Recherche Medicale [SPF20160936356]
  10. Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada
  11. Canadian Institutes of Health Research [CTP 87518]
  12. Ontario Ministry of Health and Long-Term Care
  13. Mount Sinai Hospital

向作者/读者索取更多资源

The composite outcome of mortality and significant neurodisability in extremely preterm infants differed across high-income countries with similar baseline characteristics and access to healthcare. The French cohort (EPIPAGE-2) had higher rates of the composite outcome, primarily driven by increased mortality rates.
Objective To compare mortality and rates of significant neurosensory impairment (sNSI) at 18-36 months' corrected age in infants born extremely preterm across three international cohorts. Design Retrospective analysis of prospectively collected neonatal and follow-up data. Setting Three population-based observational cohort studies: the Australian and New Zealand Neonatal Network (ANZNN), the Canadian Neonatal and Follow-up Networks (CNN/CNFUN) and the French cohort Etude (Epidemiologique sur les Petits Ages Gestationnels: EPIPAGE-2). Patients Extremely preterm neonates of Main outcome measures Primary outcome was composite of mortality or sNSI defined by cerebral palsy with no independent walking, disabling hearing loss and bilateral blindness. Results Overall, 3055 infants (ANZNN n=960, CNN/CNFUN n=1019, EPIPAGE-2 n=1076) were included in the study. Primary composite outcome rates were 21.3%, 20.6% and 28.4%; mortality rates were 18.7%, 17.4% and 26.3%; and rates of sNSI among survivors were 4.3%, 5.3% and 3.3% for ANZNN, CNN/CNFUN and EPIPAGE-2, respectively. Adjusted for gestational age and multiple births, EPIPAGE-2 had higher odds of composite outcome compared with ANZNN (OR 1.71, 95% CI 1.38 to 2.13) and CNN/CNFUN (OR 1.72, 95% CI 1.39 to 2.12). EPIPAGE-2 did have a trend of lower odds of sNDI but far short of compensating for the significant increase in mortality odds. These differences may be related to variations in perinatal approach and practices (and not to differences in infants' baseline characteristics). Conclusions Composite outcome of mortality or sNSI for extremely preterm infants differed across high-income countries with similar baseline characteristics and access to healthcare. The composite outcome of mortality and significant neurodisability in extremely low birth weight infants is compared across 3 different international cohorts (Canada, Australia/New Zealand, France). The composite outcome was higher in the French cohort, driven by a higher mortality.

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