Article Text

NEONATAL NEUROLOGICAL MORBIDITY IN EXTREMELY LOW GESTATIONAL AGE NEONATES: AN IMPROVEMENT OVER THE LAST DECADE?
  1. F Boubred1,
  2. F Arnaud1,
  3. L Fayol1,
  4. V Millet1,
  5. V Lacroze1,
  6. M Leclaire1,
  7. M Gamerre2,
  8. U Simeoni1
  1. 1Division of Neonatology, APHM, Marseille, France
  2. 2Department of Obstetrics and Gynaecology, APHM, Marseille, France

Abstract

Introduction Perinatal healthcare has improved over the past decades, whereas care to extremely low gestational age neonates (ELGAN) has become increasingly “active”. However, whether such a trend translates into a benefit in terms of neonatal neurological morbidity is still discussed.

Patients/Design Historical cohorts study of ELGAN admitted in a tertiary neonatal unit between January 1997 and December 1999 (period I, n  =  147) and between January 2004 and December 2006 (period II, n  =  266). Neonatal morbidity and cerebral ultrasound scan data have been prospectively recorded. Statistical analysis included Student’s t test and χ2 analyses.

Results (Mean ± SD) birth weight (946 ± 219 g vs 897 ± 238 g, p<0.01) and gestational age (27 ± 1 weeks vs 26.7 ± 1.3 weeks, p<0.01) was decreased in period II. Severe cerebral haemorrhage (grades III/IV) decreased from 13.6% to 6.7% (p<0.01). Cystic periventricular leucomalacia was not different between periods I and II (3.4% vs 4.9%), as were persistent periventricular echogenicities and/or isolated ventricular enlargement (4.7% vs 5.6%). Survival without cerebral ultrasound abnormalities: 24–26 weeks: period I, II (15/37, 61/111; p = 0.18); 27–28 weeks: period I, II (76/110, 128/155; p = 0.02).

Conclusion In this study, neonatal neurological morbidity in ELGAN decreased during the current decade. Further studies may address medium and long-term outcomes of temporal trends.

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