Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age: the EPI-DAF study

Pauline E. van Beek; Monique Rijken; Lisa Broeders; Hendrik J. ter Horst; Corine Koopman-Esseboom; Ellen de Kort; A.R.C. Laarman; S.M. Mulder-de Tollenaer; Katerina Steiner; Renate M.C. Swarte; Elke van Westering-Kroon; Guid Oei; Aleid G. Leemhuis; Peter Andriessen

doi:10.1136/archdischild-2023-325732

Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age: the EPI-DAF study

Pauline E. van Beek (Corresponding author), Monique Rijken, Lisa Broeders, Hendrik J. ter Horst, Corine Koopman-Esseboom, Ellen de Kort, A.R.C. Laarman, S.M. Mulder-de Tollenaer, Katerina Steiner, Renate M.C. Swarte, Elke van Westering-Kroon, Guid Oei, Aleid G. Leemhuis, Peter Andriessen

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

OBJECTIVE: After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks' gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed.

DESIGN: Population-based cohort study.

SETTING: All neonatal intensive care units in the Netherlands.

PATIENTS: All infants born between 240/7 and 266/7 weeks' gestation who were 5.5 years' corrected age (CA) in 2018-2020 were included.

MAIN OUTCOME MEASURES: Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme.

RESULTS: In the 3-year period, a total of 632 infants survived to 5.5 years' CA. Data were available for 484 infants (77%). At 5.5 years' CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks' gestation, respectively (p<0.001).

CONCLUSIONS: After lowering the threshold for supporting active treatment from 25 to 24 completed weeks' gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years' CA.

Original language	English
Pages (from-to)	272-278
Number of pages	7
Journal	Archives of Disease in Childhood : Fetal and Neonatal Edition
Volume	109
Issue number	3
Early online date	27 Nov 2023
DOIs	https://doi.org/10.1136/archdischild-2023-325732
Publication status	Published - May 2024

Funding

PvB, MR, AGvW-L, PA and EPI-DAF study group had a substantial contribution to the methodological design of the study. MR, HJtH, CK-E, EdK, ARCL, SMM, KS, RMS, EvW-K and AGvW-L had a substantial contribution to data acquisition, being the principal investigators of the 10 Dutch perinatal centres. PvB, MR, LB, AGvW-L and PA had a substantial contribution to the analysis and interpretation of the data. PvB wrote the first draft of the manuscript. PA was responsible for the financial funding of the project and supervised the project. PvB and PA are guarantors.

Funders	Funder number
Stichting Tiny & Anny van Doorne Fonds

Keywords

epidemiology
neonatology
neurology
Infant, Premature, Diseases/epidemiology
Prospective Studies
Humans
Child, Preschool
Infant
Developmental Disabilities/epidemiology
Gestational Age
Pregnancy
Female
Infant, Extremely Premature
Child
Infant, Newborn
Cohort Studies

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10.1136/archdischild-2023-325732

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Cite this

van Beek, P. E., Rijken, M., Broeders, L., ter Horst, H. J., Koopman-Esseboom, C., de Kort, E., Laarman, A. R. C., Mulder-de Tollenaer, S. M., Steiner, K., Swarte, R. M. C., van Westering-Kroon, E., Oei, G., Leemhuis, A. G., & Andriessen, P. (2024). Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age: the EPI-DAF study. Archives of Disease in Childhood : Fetal and Neonatal Edition, 109(3), 272-278. https://doi.org/10.1136/archdischild-2023-325732

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title = "Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age: the EPI-DAF study",

abstract = "OBJECTIVE: After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks' gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed.DESIGN: Population-based cohort study.SETTING: All neonatal intensive care units in the Netherlands.PATIENTS: All infants born between 240/7 and 266/7 weeks' gestation who were 5.5 years' corrected age (CA) in 2018-2020 were included.MAIN OUTCOME MEASURES: Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme.RESULTS: In the 3-year period, a total of 632 infants survived to 5.5 years' CA. Data were available for 484 infants (77%). At 5.5 years' CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks' gestation, respectively (p<0.001).CONCLUSIONS: After lowering the threshold for supporting active treatment from 25 to 24 completed weeks' gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years' CA.",

keywords = "epidemiology, neonatology, neurology, Infant, Premature, Diseases/epidemiology, Prospective Studies, Humans, Child, Preschool, Infant, Developmental Disabilities/epidemiology, Gestational Age, Pregnancy, Female, Infant, Extremely Premature, Child, Infant, Newborn, Cohort Studies",

author = "{van Beek}, {Pauline E.} and Monique Rijken and Lisa Broeders and {ter Horst}, {Hendrik J.} and Corine Koopman-Esseboom and {de Kort}, Ellen and A.R.C. Laarman and {Mulder-de Tollenaer}, S.M. and Katerina Steiner and Swarte, {Renate M.C.} and {van Westering-Kroon}, Elke and Guid Oei and Leemhuis, {Aleid G.} and Peter Andriessen",

year = "2024",

month = may,

doi = "10.1136/archdischild-2023-325732",

language = "English",

volume = "109",

pages = "272--278",

journal = "Archives of Disease in Childhood : Fetal and Neonatal Edition",

issn = "1359-2998",

publisher = "BMJ Publishing Group",

number = "3",

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van Beek, PE, Rijken, M, Broeders, L, ter Horst, HJ, Koopman-Esseboom, C, de Kort, E, Laarman, ARC, Mulder-de Tollenaer, SM, Steiner, K, Swarte, RMC, van Westering-Kroon, E, Oei, G, Leemhuis, AG & Andriessen, P 2024, 'Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age: the EPI-DAF study', Archives of Disease in Childhood : Fetal and Neonatal Edition, vol. 109, no. 3, pp. 272-278. https://doi.org/10.1136/archdischild-2023-325732

Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age: the EPI-DAF study. / van Beek, Pauline E. (Corresponding author); Rijken, Monique; Broeders, Lisa et al.
In: Archives of Disease in Childhood : Fetal and Neonatal Edition, Vol. 109, No. 3, 05.2024, p. 272-278.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age

T2 - the EPI-DAF study

AU - van Beek, Pauline E.

AU - Rijken, Monique

AU - Broeders, Lisa

AU - ter Horst, Hendrik J.

AU - Koopman-Esseboom, Corine

AU - de Kort, Ellen

AU - Laarman, A.R.C.

AU - Mulder-de Tollenaer, S.M.

AU - Steiner, Katerina

AU - Swarte, Renate M.C.

AU - van Westering-Kroon, Elke

AU - Oei, Guid

AU - Leemhuis, Aleid G.

AU - Andriessen, Peter

PY - 2024/5

Y1 - 2024/5

N2 - OBJECTIVE: After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks' gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed.DESIGN: Population-based cohort study.SETTING: All neonatal intensive care units in the Netherlands.PATIENTS: All infants born between 240/7 and 266/7 weeks' gestation who were 5.5 years' corrected age (CA) in 2018-2020 were included.MAIN OUTCOME MEASURES: Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme.RESULTS: In the 3-year period, a total of 632 infants survived to 5.5 years' CA. Data were available for 484 infants (77%). At 5.5 years' CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks' gestation, respectively (p<0.001).CONCLUSIONS: After lowering the threshold for supporting active treatment from 25 to 24 completed weeks' gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years' CA.

AB - OBJECTIVE: After lowering the Dutch threshold for active treatment from 25 to 24 completed weeks' gestation, survival to discharge increased by 10% in extremely preterm live born infants. Now that this guideline has been implemented, an accurate description of neurodevelopmental outcome at school age is needed.DESIGN: Population-based cohort study.SETTING: All neonatal intensive care units in the Netherlands.PATIENTS: All infants born between 240/7 and 266/7 weeks' gestation who were 5.5 years' corrected age (CA) in 2018-2020 were included.MAIN OUTCOME MEASURES: Main outcome measure was neurodevelopmental outcome at 5.5 years. Neurodevelopmental outcome was a composite outcome defined as none, mild or moderate-to-severe impairment (further defined as neurodevelopmental impairment (NDI)), using corrected cognitive score (Wechsler Preschool and Primary Scale of Intelligence Scale-III-NL), neurological examination and neurosensory function. Additionally, motor score (Movement Assessment Battery for Children-2-NL) was assessed. All assessments were done as part of the nationwide, standardised follow-up programme.RESULTS: In the 3-year period, a total of 632 infants survived to 5.5 years' CA. Data were available for 484 infants (77%). At 5.5 years' CA, most cognitive and motor (sub)scales were significantly lower compared with the normative mean. Overall, 46% had no impairment, 36% had mild impairment and 18% had NDI. NDI-free survival was 30%, 49% and 67% in live born children at 24, 25 and 26 weeks' gestation, respectively (p<0.001).CONCLUSIONS: After lowering the threshold for supporting active treatment from 25 to 24 completed weeks' gestation, a considerable proportion of the surviving extremely preterm children did not have any impairment at 5.5 years' CA.

KW - epidemiology

KW - neonatology

KW - neurology

KW - Infant, Premature, Diseases/epidemiology

KW - Prospective Studies

KW - Humans

KW - Child, Preschool

KW - Infant

KW - Developmental Disabilities/epidemiology

KW - Gestational Age

KW - Pregnancy

KW - Female

KW - Infant, Extremely Premature

KW - Child

KW - Infant, Newborn

KW - Cohort Studies

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U2 - 10.1136/archdischild-2023-325732

DO - 10.1136/archdischild-2023-325732

M3 - Article

C2 - 38071564

SN - 1359-2998

VL - 109

SP - 272

EP - 278

JO - Archives of Disease in Childhood : Fetal and Neonatal Edition

JF - Archives of Disease in Childhood : Fetal and Neonatal Edition

IS - 3

ER -

Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age: the EPI-DAF study

Abstract

Funding

Keywords

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Perinatal Medicine

Cite this

Neurodevelopmental outcome at 5.5 years in Dutch preterm infants born at 24-26 weeks' gestational age: the EPI-DAF study

Abstract

Funding

Keywords

Access to Document

Other files and links

Fingerprint

Research areas

Perinatal Medicine

Cite this