PMID- 29637189
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220317
IS  - 2399-9772 (Electronic)
IS  - 2399-9772 (Linking)
VI  - 2
IP  - 1
DP  - 2018
TI  - Changes in survival and neurodevelopmental outcomes of infants born at <25 weeks' 
      gestation: a retrospective observational study in tertiary centres in Japan.
PG  - e000211
LID - 10.1136/bmjpo-2017-000211 [doi]
LID - e000211
AB  - OBJECTIVE: To evaluate changes in the outcomes of infants born at <25 weeks' 
      gestation in the past decade. DESIGN: Retrospective observational study. 
      SETTINGS: A multicentre database of the Neonatal Research Network, Japan. 
      PATIENTS: A total of 3318 infants born at 22-24 weeks' gestation between periods 
      1 (2003-2007) and 2 (2008-2012) from 52 tertiary centres. MAIN OUTCOME MEASURES: 
      We compared death and neurodevelopmental impairments (NDIs) at 3 years of age, 
      including cerebral palsy (CP), visual impairments (VIs), hearing impairments 
      (HIs) and the developmental quotient (DQ) of the Kyoto Scale of Psychological 
      Development test <70, between two periods using multivariate logistic regression 
      analyses adjusted for the centre, gender, multiple gestation, maternal age, 
      caesarean delivery, antenatal steroid use, pregnancy-related hypertension, 
      clinical chorioamnionitis, congenital anomalies and birth weight. RESULTS: A 
      total of 496/1479 infants (34%) in period 1 and 467/1839 (25%) in period 2 died 
      by 3 years of age (adjusted OR 0.70, 95% CIs 0.59 to 0.83). Follow-up data were 
      collected from 631 infants (64% of survivors) in period 1 and 832 (61% of 
      survivors) in period 2. The proportions of CP with Gross Motor Function 
      Classification System >/=2, VI and HI in the infants evaluated were lower, while 
      that of DQ <70 was higher in period 2 than in period 1. Using multiple 
      imputations to account for missing data, death or NDI decreased from 54% in 
      period 1 to 47% in period 2 (0.83, 0.71 to 0.97). Significant decreases were 
      observed in death or CP (0.65, 0.55 to 0.76), death or VI (0.59, 0.50 to 0.69) 
      and death or HI (0.69, 0.58 to 0.81), but not in death or DQ <70 (0.91, 0.78 to 
      1.06). CONCLUSION: Along with improved survival, CP, VI and HI, but not cognitive 
      impairments decreased in infants born at <25 weeks' gestation between the two 
      periods examined in the last decade. Further strategies are needed to reduce 
      cognitive impairments in these infants.
FAU - Kono, Yumi
AU  - Kono Y
AUID- ORCID: 0000-0002-0647-7868
AD  - Department of Pediatrics, Jichi Medical University, Shimotsuke, Japan.
FAU - Yonemoto, Naohiro
AU  - Yonemoto N
AD  - Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, 
      Japan.
FAU - Nakanishi, Hidehiko
AU  - Nakanishi H
AD  - Department of Neonatology, Maternal and Perinatal Center, Tokyo Women's Medical 
      University, Tokyo, Japan.
FAU - Kusuda, Satoshi
AU  - Kusuda S
AD  - Department of Pediatrics, Kyorin Daigaku, Mitaka, Japan.
FAU - Fujimura, Masanori
AU  - Fujimura M
AD  - Osaka Women's and Children's Hospital, Neonatology, Izumi, Osaka, Japan.
LA  - eng
PT  - Journal Article
DEP - 20180120
PL  - England
TA  - BMJ Paediatr Open
JT  - BMJ paediatrics open
JID - 101715309
PMC - PMC5843009
OTO - NOTNLM
OT  - neonatology
OT  - neurodevelopment
OT  - outcomes research
COIS- Competing interests: None declared.
EDAT- 2018/04/11 06:00
MHDA- 2018/04/11 06:01
PMCR- 2018/01/20
CRDT- 2018/04/12 06:00
PHST- 2017/10/06 00:00 [received]
PHST- 2017/12/08 00:00 [revised]
PHST- 2017/12/11 00:00 [accepted]
PHST- 2018/04/12 06:00 [entrez]
PHST- 2018/04/11 06:00 [pubmed]
PHST- 2018/04/11 06:01 [medline]
PHST- 2018/01/20 00:00 [pmc-release]
AID - bmjpo-2017-000211 [pii]
AID - 10.1136/bmjpo-2017-000211 [doi]
PST - epublish
SO  - BMJ Paediatr Open. 2018 Jan 20;2(1):e000211. doi: 10.1136/bmjpo-2017-000211. 
      eCollection 2018.