1. The survival rate of extremely preterm newborns in Victoria (Australia) has increased since the early 1990s without an increase in major neurodevelopmental disability up to 2 years of age.
Evidence Rating Level: 2 (Good)
Study Rundown: Survival of extremely preterm (EP) newborns has increased since the late 1970s due to medical advances in perinatal and neonatal care. However, an increase in survival of EP newborns may theoretically result in more children living with neurodevelopmental disabilities. This study compared survival and neurodevelopment disability at 2 years of age for all EP children from four cohorts in different eras in Victoria, Australia; the four cohorts were from 1991-1992 (A), 1997 (B), 2005 (C), and 2016-2017 (D). The primary outcomes were survival and neurodevelopmental disability; secondary outcomes included rates of cerebral palsy, blindness, deafness, and/or developmental delay. The cohort of EP newborns in 2016-2017 had the highest survival to 2 years (73% versus 53%, 70%, and 63% in A, B, and C, respectively) and the lowest incidence of cerebral palsy (6% versus 11%, 12%, and 10% in A, B, and C, respectively) compared to the other three cohorts. Children who survived free of major neurodevelopmental disability increased over time (42%, 51%, 53%, and 62% in A, B, C, and D, respectively; odds ratio: 1.30 per decade [95% CI: 1.15-1.48]; p< 0.001). Blindness and deafness were similar across all cohorts (<3% incidence). Overall, these four cohort studies demonstrated an increase in survival without a rise in major disability up to 2 years old in EP children. One limitation of this study, however, is that follow-up was only up to 2 years of age for the 2016-2017 cohort and some neurological disabilities may not appear until later in life.
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