Changing prognosis for babies of less than 28 weeks' gestation in the north of England between 1983 and 1994

Abstract

Objective: To investigate the changing prognosis for babies of less than 28 weeks' gestation. Design: A prospective, collaborative, population based survey. Setting: The former Northern Regional Health Authority. Subjects: All the births between 1983 and 1994 at 22 to 27 completed weeks' gestation to women normally resident in the region. Main outcome measures: Miscarriage, stillbirth, death in the first year of life, and disability in survivors. Results: There were 479 070 registered births in the study period. No baby of 22 weeks' gestation survived; only eight (4%) of the 197 babies of 23 weeks who were alive at the onset of labour survived for a year–a proportion that did not change during the study period. Survival among other babies of less than 28 weeks improved progressively between 1983-6 and 1991-4, but administration of artificial surfactant to babies requiring ventilation from mid-1990 was associated with further improvement in survival only in those over 25 weeks' gestation. Babies of 24 weeks required three times as much high dependency care per survivor as babies of 27 weeks (76 v 26 days). The rate of severe disability in the one year survivors of less than 26 weeks' gestation (30/123; 24%) was similar to that seen in the sampled survivors of 26 and 27 weeks (29/108; 27%); the proportion disabled did not change significantly during the study period. All the children born in 1983, 1987, and 1991 were later reassessed in greater detail: 10% (13/136) seemed destined for a continuing life of total dependency. Conclusions: Gestation, if accurately assessed, can give a woman facing very preterm delivery a clear indication of the prognosis for her baby and help her judge the appropriateness of accepting obstetric intervention and sustained perinatal support. Key messages: Survival in babies of 24-27 completed weeks of gestation has improved in the past 12 years The proportion of survivors with severe disability (25%) has not changed The survival (viability) of babies born before 24 weeks' gestation (about 4%) has not changed, and most survivors are severely disabled One in 10 of all survivors has a disability so profound that he or she is never likely to become independently mobile or to communicate effectively with others Gestation, if accurately assessed, can help women facing very preterm delivery (and their attendants) to assess the likely prognosis for the baby at the onset of labour