CHANGING PROGNOSIS FOR BABIES OF LESS-THAN 28 WEEKS GESTATION IN THE NORTH OF ENGLAND BETWEEN 1983 AND 1994

Objective: To investigate the changing prognosis for babies of less th an 28 weeks' gestation. Design: A prospective, collaborative, populati on based survey. Setting: The former Northern Regional Health Authorit y. Subjects: All the births between 1983 and 1994 at 22 to 27 complete d weeks' gestation to women normally resident in the region. Main outc ome measures: Miscarriage, stillbirth, death in the first year of life , and disability in survivors. Results: There were 419 070 registered births in the study period. No baby of 22 weeks' gestation survived; o nly eight (4%) of the 197 babies of 23 weeks who were alive at the ons et of labour survived for a year-a proportion that did not change duri ng the study period. Survival among other babies of less than 28 weeks improved progressively between 1983-6 and 1991-4, but administration of artificial surfactant to babies requiring ventilation from mid-1990 was associated with further improvement in survival only in those ove r 25 weeks' gestation. Babies of 24 weeks required three times as much high dependency care per survivor as babies of 27 weeks (76 v 26 days ). The rate of severe disability in the one year survivors of less tha n 26 weeks' gestation (30/123; 24%) was similar to that seen in the sa mpled survivors of 26 and 27 weeks (29/108; 27%); the proportion disab led did not change significantly during the study period. All the chil dren born in 1983, 1987, and 1991 were later reassessed in greater det ail: 10% (13/136) seemed destined for a continuing life of total depen dency. Conclusions: Gestation, if accurately assessed, can give a woma n facing very preterm delivery a dear indication of the prognosis for her baby and help her judge the appropriateness of accepting obstetric intervention and sustained perinatal support.