1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Extremely Preterm Infants: Poor Long-Term Prognosis

What are the implications for resuscitation?

Understanding long-term cognitive outcomes of extremely preterm infants is critical for educational planning and ethical reasons. Investigators identified 308 children who were born in the U.K. or Ireland at less than 26 weeks' gestation; 241 were assessed at school age (median age: 6 years, 4 months).

On every cognitive and neurologic measure at the school-age follow-up, these children performed significantly worse than a group of 160 classmates who had been delivered at full term. For example, overall mean cognitive scores were 82 versus 106 (possible range, 39-150); 41% vs. 2%, respectively, had scores >2 standard deviations below a published reference mean. Twenty percent of the preterm group had cerebral palsy (vs. 0% of the full-term group).

Outcomes in the preterm group varied by gestational age at birth. For example, 12% of those born at 23 weeks' gestation, 14% of those born at 24 weeks, and 24% of those born at 25 weeks had no "overall disability," according to the school-age neurocognitive assessment.

Comment: Resuscitation of extremely preterm infants is becoming more common because of increasing parental pressure and several other factors noted by the editorialists (greater use of assisted reproductive technology, publicity about "miracle babies," and advanced maternal age). This growing trend toward resuscitation often conflicts with current American Academy of Pediatrics guidelines, which deem it appropriate not to resuscitate infants born at <23 weeks' gestation. After spending months in the neonatal intensive care unit, nearly all extremely preterm infants will have moderate or severe neurocognitive disabilities as children. Although the editorialists suggest that these children can show some resilience as they get older, it is more likely that as the intellectual challenges of childhood increase, so will the differences between preterm children and their peers.

— Howard Bauchner, MD

Published in Journal Watch General Medicine January 18, 2005

Citation(s):

Marlow N et al. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 2005 Jan 6; 352:9-19.

• Original article (Subscription may be required)
• Medline abstract (Free)

Vohr BR and Allen M. Extreme prematurity -- The continuing dilemma. N Engl J Med 2005 Jan 6; 352:71-2.

• Original article (Subscription may be required)
• Medline abstract (Free)