Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies)
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OBJECTIVE: To determine survival and neonatal morbidity for babies born between 22 and 26 weeks' gestation in England during 2006, and to evaluate changes in outcome since 1995 for babies born between 22 and 25 weeks' gestation. DESIGN: Prospective national cohort studies. SETTING: Maternity and neonatal units in England. PARTICIPANTS: 3133 births between 22 and 26 weeks' gestation in 2006; 666 admissions to neonatal units in 1995 and 1115 in 2006 of babies born between 22 and 25 weeks' gestation. MAIN OUTCOME MEASURES: Survival to discharge from hospital, pregnancy and delivery outcomes, infant morbidity until discharge. RESULTS: In 2006, survival of live born babies was 2% (n=3) for those born at 22 weeks' gestation, 19% (n=66) at 23 weeks, 40% (n=178) at 24 weeks, 66% (n=346) at 25 weeks, and 77% (n=448) at 26 weeks (P<0.001). At discharge from hospital, 68% (n=705) of survivors had bronchopulmonary dysplasia (receiving supplemental oxygen at 36 weeks postmenstrual age), 13% (n=135) had evidence of serious abnormality on cerebral ultrasonography, and 16% (n=166) had laser treatment for retinopathy of prematurity. For babies born between 22 and 25 weeks' gestation from March to December, the number of admissions for neonatal care increased by 44%, from 666 in 1995 to 959 in 2006. By 2006 adherence to evidence based practice associated with improved outcome had significantly increased. Survival increased from 40% to 53% (P<0.001) overall and at each week of gestation: by 9.5% (confidence interval -0.1% to 19%) at 23 weeks, 12% (4% to 20%) at 24 weeks, and 16% (9% to 23%) at 25 weeks. The proportions of babies surviving in 2006 with bronchopulmonary dysplasia, major cerebral scan abnormality, or weight and/or head circumference <-2 SD were similar to those in 1995, but the proportion treated for retinopathy of prematurity had increased from 13% to 22% (P=0.006). Predictors of mortality and morbidity were similar in both cohorts. CONCLUSION: Survival of babies born between 22 and 25 weeks' gestation has increased since 1995 but the pattern of major neonatal morbidity and the proportion of survivors affected are unchanged. These observations reflect an important increase in the number of preterm survivors at risk of later health problems.
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With an increase in live births at 22+0 to 23+6 weeks of gestation receiving neonatal care and surviving to be taken home by their parents and also increases in babies registered as 'live born' before 22 weeks of gestation in the UK in recent years, use of the word 'miscarriage' to describe the death of any baby before 24 weeks of gestation in the UK is problematic.
“With an increase in live births at 22+0 to 23+6 weeks of gestation receiving neonatal care and surviving to be taken home by their parents14, 15 and also increases in babies registered as ‘live born’ before 22 weeks of gestation in the UK in recent years (https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/datasets/birthcharacteristicsinenglandandwales; accessed”
From Parents’ experiences of care following the loss of a baby at the margins between miscarriage, stillbirth and neonatal death: a UK qualitative study (2020) · cites this paper as [14]
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Cites
Jobe, A. H., & Bancalari, E. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.163.7.2011060 · Cited by 4,817 · see citing works
The International Classification of Retinopathy of Prematurity Revisited
Prematurity*, C. O. R. O. (2005) · Archives of Ophthalmology · doi:10.1001/archopht.123.7.991 · Cited by 2,939 · see citing works
An overview of mortality and sequelae of preterm birth from infancy to adulthood
Saigal, S., & Doyle, L. W. (2008) · The Lancet · doi:10.1016/s0140-6736(08)60136-1 · Cited by 2,818 · see citing works
Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth
Roberts, D., Brown, J., Medley, N., & Dalziel, S. R. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004454.pub3 · Cited by 2,806 · see citing works
Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth
Roberts, D., & Dalziel, S. R. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004454.pub2 · Cited by 1,591 · see citing works
Gole, G. A., Ells, A. L., Katz, X., Holmström, G. E., Fielder, A. R., Capone, A., Flynn, J. T., Good, W., Holmes, J. M., McNamara, J. A., et al. (2005) · Archives of Ophthalmology · Cited by 1,386 · see citing works
Nasal CPAP or Intubation at Birth for Very Preterm Infants
Morley, C. J., Davis, P. G., Doyle, L. W., Brion, L. P., Hascoët, J., & Carlin, J. B. (2008) · New England Journal of Medicine · doi:10.1056/nejmoa072788 · Cited by 1,351 · see citing works
Early CPAP versus Surfactant in Extremely Preterm Infants
SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network (2010) · New England Journal of Medicine · doi:10.1056/nejmoa0911783 · Cited by 1,043 · see citing works
Costeloe, K., Hennessy, E., Gibson, A. T., Marlow, N., Wilkinson, A. R., & for the EPICure Study Group (2000) · PEDIATRICS · doi:10.1542/peds.106.4.659 · Cited by 1,004 · see citing works
Self-citationThe International Neonatal Network (1993) · The Lancet · doi:10.1016/0140-6736(93)92296-6 · Cited by 773 · see citing works
One-Year Survival of Extremely Preterm Infants After Active Perinatal Care in Sweden
(2009) · JAMA · doi:10.1001/jama.2009.771 · Cited by 662 · see citing works
Antenatal care : routine care for the healthy pregnant woman
Excellence, C. (2008) · RCOG Press eBooks · Cited by 628 · see citing works
Fawke, J., Lum, S., Kirkby, J. C., Hennessy, E., Marlow, N., Rowell, V., Thomas, S., & Stocks, J. (2010) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200912-1806oc · Cited by 533 · see citing works
Self-citationInterventions to prevent hypothermia at birth in preterm and/or low birth weight infants
McCall, E. M., Alderdice, F. A., Halliday, H. L., Vohra, S., & Johnston, L. J. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004210.pub5 · Cited by 471 · see citing works
Göpel, W., Kribs, A., Ziegler, A., et al. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60986-0 · Cited by 467 · see citing works
Wood, N. S., Costeloe, K., Gibson, A. T., Hennessy, E. M., Marlow, N., & Wilkinson, A. R. (2005) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2004.052407 · Cited by 419 · see citing works
Self-citationAutism Spectrum Disorders in Extremely Preterm Children
Johnson, S., Hollis, C., Kochhar, P., Hennessy, E., Wolke, D., & Marlow, N. (2010) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2009.10.041 · Cited by 366 · see citing works
Self-citationSchulman, J. D., Stricof, R. L., Stevens, T. P., Horgan, M. J., Gase, K., Holzman, I. R., Koppel, R. I., Nafday, S. M., Gibbs, K., Angert, R. M., et al. (2011) · PEDIATRICS · doi:10.1542/peds.2010-2873 · Cited by 313 · see citing works
Walker, S. M., Franck, L. S., Fitzgerald, M., Myles, J. P., Stocks, J., & Marlow, N. (2008) · Pain · doi:10.1016/j.pain.2008.10.012 · Cited by 290 · see citing works
Self-citationNeurodevelopmental Disability Through 11 Years of Age in Children Born Before 26 Weeks of Gestation
Johnson, S. J., Fawke, J., Hennessy, E., Rowell, V., Thomas, S., Dieter Wolke, C., & Marlow, N. (2009) · PEDIATRICS · doi:10.1542/peds.2008-3743 · Cited by 276 · see citing works
Self-citationNeurocognitive outcome after very preterm birth
Marlow, N. (2004) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2002.019752 · Cited by 271 · see citing works
Self-citationJohnson, S. J., Dieter Wolke, C., Hennessy, E., & Marlow, N. (2011) · Developmental Neuropsychology · doi:10.1080/87565641.2011.540541 · Cited by 246 · see citing works
Self-citationField, D. J., Dorling, J., Manktelow, B. N., et al. (2008) · BMJ · doi:10.1136/bmj.39555.670718.be · Cited by 237 · see citing works
The Vermont Oxford Network: Evidence-Based Quality Improvement for Neonatology
Horbar, J. D. (1999) · PEDIATRICS · doi:10.1542/peds.103.se1.350 · Cited by 237 · see citing works
Postnatal Corticosteroids to Prevent or Treat Bronchopulmonary Dysplasia
Watterberg, K. L. (2010) · PEDIATRICS · doi:10.1542/peds.2010-1534 · Cited by 235 · see citing works
Beaino, G., Khoshnood, B., Kaminski, M., Pierrat, V., Marret, S., Matis, J., Ledésert, B., Thiriez, G., Fresson, J., Rozé, J., et al. (2010) · Developmental Medicine & Child Neurology · doi:10.1111/j.1469-8749.2010.03612.x · Cited by 195 · see citing works
Håkansson, S., Farooqi, A., Holmgren, P. A., Serenius, F., & Högberg, U. (2004) · PEDIATRICS · doi:10.1542/peds.114.1.58 · Cited by 193 · see citing works
Hintz, S. R., Kendrick, D. E., Wilson-Costello, D. E., Das, A., Bell, E. F., Vohr, B. R., & Higgins, R. D. (2010) · PEDIATRICS · doi:10.1542/peds.2010-1150 · Cited by 177 · see citing works
Postnatal Corticosteroids to Prevent or Treat Bronchopulmonary Dysplasia
Watterberg, K. L. (2013) · American Academy of Pediatrics eBooks · doi:10.1542/9781581108224-postnatal_sub01 · Cited by 166 · see citing works
McCall (2010) · doi:10.1002/14651858.cd004210.pub4 · Cited by 150 · see citing works
Overview of Surfactant Replacement Trials
Suresh, G., & Soll, R. F. (2005) · Journal of Perinatology · doi:10.1038/sj.jp.7211320 · Cited by 106 · see citing works
Changing long-term outcomes for infants 500–999 g birth weight in Victoria, 1979–2005
Doyle, L. W., Roberts, G., Anderson, P. J., et al. (2011) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2010.200576 · Cited by 72 · see citing works
Cardiovascular consequences of extreme prematurity: the EPICure study
McEniery, C. M., Bolton, C. E., Fawke, J., Hennessy, E., Stocks, J., Wilkinson, I. B., Cockcroft, J. R., & Marlow, N. (2011) · Journal of Hypertension · doi:10.1097/hjh.0b013e328347e333 · Cited by 68 · see citing works
Self-citationRates of very preterm birth in Europe and neonatal mortality rates
Field, D. J., Draper, E. S., Fenton, A. C., Papiernik, E., Zeitlin, J. A., Blondel, B., Cuttini, M., Maier, R. F., Weber, T., Carrapato, M., et al. (2008) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2008.150433 · Cited by 53 · see citing works
Self-citationManaging Oxygen Therapy during Delivery Room Stabilization of Preterm Infants
Dawson, J. A., Vento, M., Finer, N. N., et al. (2011) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2011.07.045 · Cited by 53 · see citing works
Establishing neonatal networks: the reality
Marlow, N., & Gill, A. (2006) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/adc.2005.086413 · Cited by 53 · see citing works
Self-citationThe intestinal microbiome of infants and the use of probiotics
Indrio, F., & Neu, J. (2011) · Current Opinion in Pediatrics · doi:10.1097/mop.0b013e3283444ccb · Cited by 48 · see citing works
Fanaroff, A. A. (2012) · Yearbook of Neonatal and Perinatal Medicine · doi:10.1016/j.ynpm.2012.05.004 · Cited by 26 · see citing works
National neonatal data to support specialist care and improve infant outcomes
Spencer, A., & Modi, N. (2012) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/archdischild-2011-300872 · Cited by 24 · see citing works
Draper, E. S., Alfirević, Ž., Stacey, F., Hennessy, E., Costeloe, K., & for the EPICure Study Group (2012) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2012.03285.x · Cited by 12 · see citing works
Self-citationField, D., Dorling, J. S., Manktelow, B. N., & Draper, E. S. (2008) · Obstetric Anesthesia Digest · doi:10.1097/01.aoa.0000337912.40384.c1 · Cited by 11 · see citing works
Self-citationMesserschmidt, A., Olischar, M., Birnbacher, R., et al. (2010) · Neonatology · doi:10.1159/000313969 · Cited by 8 · see citing works
Early CPAP versus Surfactant in Extremely Preterm Infants
Fanaroff, A. A. (2011) · Yearbook of Neonatal and Perinatal Medicine · doi:10.1016/j.ynpm.2011.07.037 · Cited by 8 · see citing works
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Villar, J., Ismail, L. C., Victora, C. G., Ohuma, E. O., Bertino, E., Altman, D. G., Lambert, A., Papageorghiou, A. T., Carvalho, M., Jaffer, Y. A., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(14)60932-6 · Cited by 2,281 · see citing works
Allotey, J., Zamora, J., Cheong‐See, F., Kalidindi, M., Arroyo‐Manzano, D., Asztalos, E., van der Post, J., Mol, B., Moore, D., Birtles, D., et al. (2018) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.14832 · Cited by 551 · see citing works
Lees, C., Marlow, N., Arabin, B., Bilardo, C. M., Brezinka, C., Derks, J. B., Duvekot, J., Frusca, T., Diemert, A., Ferrazzi, E., et al. (2013) · Ultrasound in Obstetrics & Gynecology · doi:10.1002/uog.13190 · Cited by 540 · see citing works
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Stocks, J., Hislop, A., & Sonnappa, S. (2013) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(13)70118-8 · Cited by 390 · see citing works
Serenius, F., Ewald, U., Farooqi, A., Fellman, V., Hafström, M., Hellgren, K., Maršál, K., Ohlin, A., Olhager, E., Stjernqvist, K., et al. (2016) · JAMA Pediatrics · doi:10.1001/jamapediatrics.2016.1210 · Cited by 310 · see citing works
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Sim, K., Shaw, A. G., Randell, P., Cox, M. J., McClure, Z. E., Li, M.-S., Haddad, M., Langford, P. R., Cookson, W. O. C. M., Moffatt, M. F., et al. (2015) · Clinical Infectious Diseases · doi:10.1093/cid/ciu822 · Cited by 224 · see citing works
Santhakumaran, S., Statnikov, Y., Gray, D., Battersby, C., Ashby, D., & Modi, N. (2018) · Archives of Disease in Childhood - Fetal and Neonatal Edition · doi:10.1136/archdischild-2017-312748 · Cited by 189 · see citing works
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Torchin, H., & Ancel, P.-Y. (2016) · Journal de Gynécologie Obstétrique et Biologie de la Reproduction · doi:10.1016/j.jgyn.2016.09.013 · Cited by 134 · see citing works
Smith, L., Dickens, J., Bender Atik, R., Bevan, C., Fisher, J., & Hinton, L. (2020) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.16113 · Cited by 119 · see citing works
Carson, C., Redshaw, M., Gray, R., & Quigley, M. A. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-007942 · Cited by 90 · see citing works
Monier, I., Ego, A., Benachi, A., Ancel, P.-Y., Goffinet, F., & Zeitlin, J. (2018) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2018.08.012 · Cited by 32 · see citing works
- Authors
- Costeloe, K. L., Hennessy, E. M., Haider, S., Stacey, F., Marlow, N., & Draper, E. S.
- Affiliations
- Queen Mary University of London (GB)
- University College London (GB)
- University of Leicester (GB)
- Corresponding author
- Costeloe, K. L.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2012-12-04
- Volume
- 345
- Issue
- dec04 3
- Pages
- e7976-e7976
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC3514472
- OpenAlex
- W1981360765
- Cited by
- 816
- References
- 44
- Citations by year
- 2026: 20 · 2025: 30 · 2024: 39 · 2023: 56 · 2022: 44 · 2021: 84 · 2020: 61 · 2019: 63 · 2018: 78 · 2017: 74 · 2016: 83 · 2015: 76 · 2014: 60 · 2013: 40 · 2012: 5
- FWCI
- 50.90
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion, cc-by-nc)
- Figshare (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
- Funders
- Medical Research Council (G0401525)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
- Keywords
- extremely preterm birth, extremely low gestational age, survival to hospital discharge, neonatal morbidity, bronchopulmonary dysplasia, retinopathy of prematurity, neonatal intensive care admission, cranial ultrasound, evidence-based practice, EPICURE, temporal trends in outcomes, England, neonatal outcomes
- MeSH terms
- England, Female, Gestational Age, Humans, Infant Mortality, Infant, Newborn, Infant, Premature, Diseases, Obstetric Labor Complications, Male, Patient Discharge, Pregnancy, Pregnancy Outcome, Prospective Studies, Risk Factors, Cohort Studies, Intensive Care, Neonatal, Linear Models, Logistic Models, Outcome Assessment, Health Care, Practice Guidelines as Topic, Guideline Adherence, Kaplan-Meier Estimate, Infant, Extremely Premature
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