Abstract
Despite providing intensive care to more infants born <24 weeks’ gestation, data on school-age outcomes, critical for counselling and decision-making, are sparse.ObjectiveTo compare major neurosensory, cognitive and academic impairment among school-aged children born extremely preterm at 22–23 weeks’ gestation (EP22–23) with those born 24–25 weeks (EP24–25), 26–27 weeks (EP26–27) and term (≥37 weeks).DesignThree prospective longitudinal cohorts.SettingVictoria, Australia.ParticipantsAll EP live births (22–27 weeks) and term-born controls born in 1991–1992, 1997 and 2005.Main outcome measuresAt 8 years, major neurosensory disability (any of moderate/severe cerebral palsy, IQ <−2 SD relative to controls, blindness or deafness), motor, cognitive and academic impairment, executive dysfunction and poor health utility. Risk ratios (RRs) and risk differences between EP22–23 (reference) and other gestational age groups were estimated using generalised linear models, adjusted for era of birth, social risk and multiple birth.ResultsThe risk of major neurosensory disability was higher for EP22–23 (n=21) than more mature groups (168 EP24–25; 312 EP26–27; 576 term), with increasing magnitude of difference as the gestation increased (adjusted RR (95% CI) compared with EP24–25: 1.39 (0.70 to 2.76), p=0.35; EP26–27: 1.85 (0.95 to 3.61), p=0.07; term: 13.9 (5.75 to 33.7), p<0.001). Similar trends were seen with other outcomes. Two-thirds of EP22–23 survivors were free of major neurosensory disability.ConclusionsAlthough children born EP22–23 experienced higher rates of disability and impairment at 8 years than children born more maturely, many were free of major neurosensory disability. These data support providing active care to infants born EP22–23.