[Survival and neurologic outcomes after extremely preterm birth].

Objective: To determine survival and neurologic outcomes at 2 years after extremely preterm birth.

Methods: A retrospective study including all births (live births and stillbirths) and late terminations of pregnancy at 22-26 completed weeks' gestation in the Pays de la Loire region of France in 2004-2005. We determined survival rates, factors associated with death in neonatal intensive care units (NICUs), and neurologic assessment at the corrected age of 2 years by the Loire Infant Follow-up Team (LIFT).

Results: A total of 444 births were recorded, 37% were medical terminations of pregnancy, 34% were stillbirths, and 29% were live births. Among the 129 hospitalized live births, the survival rate at discharge was 47% (13.7% of all obstetrical outcomes). Mortality decreased with gestational age (P=0.02) and cesarean section (P=0.03). Mortality was higher after extrauterine transport (OR=4.44; 95% CI [1.63-12.12]; P<0.01) and in cases of grade III or IV intraventricular hemorrhage (OR=13.7; 95% CI [4.85-38.5]; P<0.01). The NICU where infants were admitted, gender, multiple birth, and birth weight did not alter mortality. At the corrected age of 2years, 26% of survivors had a normal neurologic assessment, whereas 31% had severe abnormal neurologic outcome.

Conclusion: In our study, survival and neurologic outcomes of extremely preterm infants were poor. An extended neurologic follow-up seems necessary for these children, in order to diagnose and manage any subsequent disability.