Survival and Morbidity of Preterm Children Born at 22 Through 34 Weeks’ Gestation in France in 2011

Pierre-Yves Ancel (1) , François Goffinet (1) , Pierre Kuhn , Bruno Langer (2) , Jacqueline Matis , Xavier Hernandorena , Pierre Chabanier (3) , Laurence Joly-Pedespan , Bénédicte Lecomte , Françoise Vendittelli (4) , Michel Dreyfus (5) , Bernard Guillois (6) , Antoine Burguet (1) , Pierre Sagot (7) , Jacques Sizun (8) , Alain Beuchée (9, 10) , Florence Rouget (11, 10) , Amélie Favreau , Elie Saliba (12) , Nathalie Bednarek (13) , Patrice Morville (14) , Gérard Thiriez (15) , Loïc Marpeau (5) , Stéphane Marret (16, 17) , Gilles Kayem (18) , Xavier Durrmeyer (19) , Michèle Granier (20) , Olivier Baud (21) , Pierre-Henri Jarreau (22) , Delphine Mitanchez (23) , Pascal Boileau (24) , Pierre Boulot (25) , Gilles Cambonie (26) , Hubert Daudé (27) , Antoine Bédu (28) , Fabienne Mons , Jeanne Fresson (29) , Rachel Vieux (30) , Catherine Alberge , Catherine Arnaud (31) , Christophe Vayssiere (32) , Patrick Truffert (1) , Véronique Pierrat (1) , Damien Subtil (33) , Claude D’ercole , Catherine Gire (34) , Umberto Siméoni (35) , André Bongain (36) , Loïc Sentilhes (37) , Jean-Christophe Roze (38) , Jean Gondry (39) , André Leke (40) , Michel Deiber , Olivier Claris (41) , Jean-Charles Picaud (42) , Anne Ego (33) , Thierry Debillon (43) , Anne Poulichet , Eliane Coliné , Anne Favre (44) , Olivier Fléchelles , Sylvain Samperiz (45) , Duksha Ramful (45) , Bernard Branger (46) , Valérie Benhammou (47) , Laurence Foix-L’hélias , Laetitia Marchand-Martin (48) , Monique Kaminski (1)

1 UMR_S 953 - Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants
2 Service de gynécologie–obstétrique
3 Centre de compétences des microangiopathies thrombotiques
4 IP - Institut Pascal
5 Service de Gynécologie-Obstétrique et Médecine de la Reproduction [CHU Caen]
6 CHU Caen
7 Service de Gynécologie Obstétrique, Médecine Foetale et Stérilité Conjugale - Chirurgie Gynécologie et Oncologique [CHU de Dijon]
8 Département de Pédiatrie
9 LTSI - Laboratoire Traitement du Signal et de l'Image
10 Irset - Institut de recherche en santé, environnement et travail
11 CHU Pontchaillou [Rennes]
12 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
13 CRESTIC - Centre de Recherche en Sciences et Technologies de l'Information et de la Communication - EA 3804
14 Service de cardiologie pédiatrique
15 Service de pédiatrie [CHRU Besançon]
16 Neovasc - Team 4 NeoVasc - Region Team ERI 28 INSERM
17 GPMCND - Génomique et Médecine Personnalisée du Cancer et des Maladies Neuropsychiatriques
18 Service de Gynécologie-Obstétrique [Colombes]
19 IMRB - Institut Mondor de Recherche Biomédicale
20 Médecine néonatale
21 Physiopathologie, conséquences fonctionnelles et neuroprotection des atteintes du cerveau en développement
22 PremUp Foundation
23 CHU Trousseau [APHP]
24 RISCQ - Risques cliniques et sécurité en santé des femmes et en santé périnatale
25 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
26 Service de Néonatalogie
27 AMU - Aix Marseille Université
28 Service de Pédiatrie médicale - réanimation et néonatologie [CHU Limoges]
29 Comité consultatif sur le traitement de l'information en matière de recherche dans le domaine de la santé
30 Unité de Néonatalogie
31 INSERM, U1027, Toulouse, France.
32 Service Gynécologie [CHU Toulouse]
33 Unité de Recherche Clinique
34 Département de Pédiatrie-Néonatologie
35 VRCM - Vascular research center of Marseille
36 Service de Gynécologie-Obstétrique-Reproduction
37 Service de gynécologie-obstétrique
38 Département de Périnatologie
39 TMCD2 - Transporteurs membranaires, chimioresistance et drug-design
40 CHU Amiens-Picardie
41 SIS - Santé Individu Société - SIS
42 Service de Néonatalogie [Lyon]
43 Registre des Handicaps de l'Enfant et Observatoire Périnatal Isère
44 Réseau Périnat de Guyane [Cayenne, Guyanne Française]
45 CHU La Réunion - Centre Hospitalier Universitaire de La Réunion
46 Réseau Sécurité Naissance - Naître Ensemble, Nantes
47 CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
48 CRESS - U1153 - Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique

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.

Keywords: cohort; neonatal morbidity

Domains: Life Sciences [q-bio]

Pierre-Yves Ancel, François Goffinet, Pierre Kuhn, Bruno Langer, Jacqueline Matis, et al.. Survival and Morbidity of Preterm Children Born at 22 Through 34 Weeks’ Gestation in France in 2011. Medicine Archives of Pediatrics & Adolescent - JAMA Pediatrics , 2015, 169 (3), pp.230. ⟨10.1001/jamapediatrics.2014.3351⟩. ⟨hal-02462370⟩