Survival and Morbidity of Preterm Children Born at 22 Through 34 Weeks’ Gestation in France in 2011: Results of the EPIPAGE-2 Cohort Study | Cerebrovascular Disease | JAMA Pediatrics | JAMA Network
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Fellman  V, Hellström-Westas  L, Norman  M,  et al; EXPRESS Group.  One-year survival of extremely preterm infants after active perinatal care in Sweden.  JAMA. 2009;301(21):2225-2233.PubMedGoogle ScholarCrossref
Costeloe  KL, Hennessy  EM, Haider  S, Stacey  F, Marlow  N, Draper  ES.  Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies).  BMJ. 2012;345:e7976.PubMedGoogle ScholarCrossref
Field  DJ, Dorling  JS, Manktelow  BN, Draper  ES.  Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994-9 compared with 2000-5.  BMJ. 2008;336(7655):1221-1223.PubMedGoogle ScholarCrossref
Stoll  BJ, Hansen  NI, Bell  EF,  et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.  Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network.  Pediatrics. 2010;126(3):443-456.PubMedGoogle ScholarCrossref
Bode  MM, D’Eugenio  DB, Forsyth  N, Coleman  J, Gross  CR, Gross  SJ.  Outcome of extreme prematurity: a prospective comparison of 2 regional cohorts born 20 years apart.  Pediatrics. 2009;124(3):866-874.PubMedGoogle ScholarCrossref
Doyle  LW, Roberts  G, Anderson  PJ; Victorian Infant Collaborative Study Group.  Outcomes at age 2 years of infants < 28 weeks’ gestational age born in Victoria in 2005.  J Pediatr. 2010;156(1):49-53.e1.PubMedGoogle ScholarCrossref
Itabashi  K, Horiuchi  T, Kusuda  S,  et al.  Mortality rates for extremely low birth weight infants born in Japan in 2005.  Pediatrics. 2009;123(2):445-450.PubMedGoogle ScholarCrossref
Marlow  N, Wolke  D, Bracewell  MA, Samara  M; EPICure Study Group.  Neurologic and developmental disability at six years of age after extremely preterm birth.  N Engl J Med. 2005;352(1):9-19.PubMedGoogle ScholarCrossref
Herber-Jonat  S, Schulze  A, Kribs  A, Roth  B, Lindner  W, Pohlandt  F.  Survival and major neonatal complications in infants born between 22 0/7 and 24 6/7 weeks of gestation (1999-2003).  Am J Obstet Gynecol. 2006;195(1):16-22.PubMedGoogle ScholarCrossref
De Groote  I, Vanhaesebrouck  P, Bruneel  E,  et al; Extremely Preterm Infants in Belgium (EPIBEL) Study Group.  Outcome at 3 years of age in a population-based cohort of extremely preterm infants.  Obstet Gynecol. 2007;110(4):855-864.PubMedGoogle ScholarCrossref
Blencowe  H, Cousens  S, Oestergaard  MZ,  et al.  National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications.  Lancet. 2012;379(9832):2162-2172.PubMedGoogle ScholarCrossref
Saigal  S, Doyle  LW.  An overview of mortality and sequelae of preterm birth from infancy to adulthood.  Lancet. 2008;371(9608):261-269.PubMedGoogle ScholarCrossref
Larroque  B, Ancel  PY, Marret  S,  et al; EPIPAGE Study group.  Neurodevelopmental disabilities and special care of 5-year-old children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study.  Lancet. 2008;371(9615):813-820.PubMedGoogle ScholarCrossref
Ancel  PY, Goffinet  F; EPIPAGE 2 Writing Group.  EPIPAGE 2: a preterm birth cohort in France in 2011.  BMC Pediatr. 2014;14:97.PubMedGoogle ScholarCrossref
Volpe  JJ.  Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances.  Lancet Neurol. 2009;8(1):110-124.PubMedGoogle ScholarCrossref
Bell  MJ, Ternberg  JL, Feigin  RD,  et al.  Neonatal necrotizing enterocolitis: therapeutic decisions based upon clinical staging.  Ann Surg. 1978;187(1):1-7.PubMedGoogle ScholarCrossref
International Committee for the Classification of Retinopathy of Prematurity (ICCROP).  The International Classification of Retinopathy of Prematurity revisited.  Arch Ophtalmol (Paris). 2005;123(7):991-999.PubMedGoogle ScholarCrossref
Jobe  AH, Bancalari  E.  Bronchopulmonary dysplasia.  Am J Respir Crit Care Med. 2001;163(7):1723-1729.PubMedGoogle ScholarCrossref
Larroque  B, Bréart  G, Kaminski  M,  et al; Epipage Study group.  Survival of very preterm infants: Epipage, a population based cohort study.  Arch Dis Child Fetal Neonatal Ed. 2004;89(2):F139-F144.PubMedGoogle ScholarCrossref
Moriette  G, Rameix  S, Azria  E,  et al; Groupe de réflexion sur les aspects éthiques de la périnatologie.  Very premature births: dilemmas and management: second part: ethical aspects and recommendations [in French].  Arch Pediatr. 2010;17(5):527-539.PubMedGoogle ScholarCrossref
de Waal  CG, Weisglas-Kuperus  N, van Goudoever  JB, Walther  FJ; NeoNed Study Group; LNF Study Group.  Mortality, neonatal morbidity and two year follow-up of extremely preterm infants born in The Netherlands in 2007.  PLoS One. 2012;7(7):e41302.PubMedGoogle ScholarCrossref
Joseph  KS, Liu  S, Rouleau  J,  et al; Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System.  Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study.  BMJ. 2012;344:e746.PubMedGoogle ScholarCrossref
Serenius  F, Källén  K, Blennow  M,  et al; EXPRESS Group.  Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden.  JAMA. 2013;309(17):1810-1820.PubMedGoogle ScholarCrossref
Moore  T, Hennessy  EM, Myles  J,  et al.  Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies.  BMJ. 2012;345:e7961.PubMedGoogle ScholarCrossref
Hintz  SR, Kendrick  DE, Wilson-Costello  DE,  et al; NICHD Neonatal Research Network.  Early-childhood neurodevelopmental outcomes are not improving for infants born at <25 weeks’ gestational age.  Pediatrics. 2011;127(1):62-70.PubMedGoogle ScholarCrossref
Original Investigation
March 2015

Survival and Morbidity of Preterm Children Born at 22 Through 34 Weeks’ Gestation in France in 2011: Results of the EPIPAGE-2 Cohort Study

Author Affiliations
  • 1Obstetrical, Perinatal, and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France
  • 2Paris Descartes University, Paris, France
  • 3Clinical Research Unit, Center for Clinical Investigation P1419, Cochin Broca Hotel–Dieu Hospital, Paris, France
  • 4Maternité Port-Royal, Hospital University Department Risks in Pregnancy, Cochin Brocha Hotel–Dieu Hospital, Paris, France
JAMA Pediatr. 2015;169(3):230-238. doi:10.1001/jamapediatrics.2014.3351

Importance  Up-to-date estimates of the health outcomes of preterm children are needed for assessing perinatal care, informing parents, making decisions about care, and providing evidence for clinical guidelines.

Objectives  To determine survival and neonatal morbidity of infants born from 22 through 34 completed weeks’ gestation in France in 2011 and compare these outcomes with a comparable cohort in 1997.

Design, Setting, and Participants  The EPIPAGE-2 study is a national, prospective, population-based cohort study conducted in all maternity and neonatal units in France in 2011. A total of 2205 births (stillbirths and live births) and terminations of pregnancy at 22 through 26 weeks’ gestation, 3257 at 27 through 31 weeks, and 1234 at 32 through 34 weeks were studied. Cohort data were collected from January 1 through December 31, 1997, and from March 28 through December 31, 2011. Analyses for 1997 were run for the entire year and then separately for April to December; the rates for survival and morbidities did not differ. Data are therefore presented for the whole year in 1997 and the 8-month and 6-month periods in 2011.

Main Outcomes and Measures  Survival to discharge and survival without any of the following adverse outcomes: grade III or IV intraventricular hemorrhage, cystic periventricular leukomalacia, severe bronchopulmonary dysplasia, retinopathy of prematurity (stage 3 or higher), or necrotizing enterocolitis (stages 2-3).

Results  A total of 0.7% of infants born before 24 weeks’ gestation survived to discharge: 31.2% of those born at 24 weeks, 59.1% at 25 weeks, and 75.3% at 26 weeks. Survival rates were 93.6% at 27 through 31 weeks and 98.9% at 32 through 34 weeks. Infants discharged home without severe neonatal morbidity represented 0% at 23 weeks, 11.6% at 24 weeks, 30.0% at 25 weeks, 47.5% at 26 weeks, 81.3% at 27 through 31 weeks, and 96.8% at 32 through 34 weeks. Compared with 1997, the proportion of infants surviving without severe morbidity in 2011 increased by 14.4% (P < .001) at 25 through 29 weeks and 6% (P < .001) at 30 through 31 weeks but did not change appreciably for those born at less than 25 weeks. The rates of antenatal corticosteroid use, induced preterm deliveries, cesarean deliveries, and surfactant use increased significantly in all gestational-age groups, except at 22 through 23 weeks.

Conclusions and Relevance  The substantial improvement in survival in France for newborns born at 25 through 31 weeks’ gestation was accompanied by an important reduction in severe morbidity, but survival remained rare before 25 weeks. Although improvement in survival at extremely low gestational age may be possible, its effect on long-term outcomes requires further studies. The long-term results of the EPIPAGE-2 study will be informative in this regard.