INCREASED SURVIVAL AND DETERIORATING DEVELOPMENTAL OUTCOME IN 23 TO 25 WEEK OLD GESTATION INFANTS, 1990-4 COMPARED WITH 1984-9

Aim-To assess whether changes in survival over time in infants of 23 t o 25 weeks of gestational age were accompanied by changes in the incid ence of disability in childhood during an 11 year period. Methods-Obst etric and neonatal variables having the strongest association with bot h survival to discharge from a regional neonatal medical unit and neur odevelopmental disability in 192 infants of 23 to 25 weeks of gestatio n, born in 1984 to 1994, were studied as a group and in two cohorts (1 984 to 1989 n = 96 and 1990 to 1994 n = 96). The data collected includ ed CRIB (clinical risk index for babies) scores and cranial ultrasound scan findings. The children were followed up at outpatient clinics. R esults-Between 1984 and 1989 (cohort 1) and 1990 and 1994 (cohort 2) t he rate of survival to discharge increased significantly from 27% to 4 2% and the rate of disability in survivors increased from 38% to 68%; most of this increase was in mild disability. The proportions of survi vors with cerebral palsy did not alter significantly (21% vs 18%), but more survivors with blindness due to retinopathy of prematurity (4% v s 18%), myopia (4% vs 15%) and squints (8% vs 13%) contributed to the increased rate of disability. Clinically significant cranial ultrasoun d findings and a high CRIB score were strongly associated with death. A high CRIB score was most strongly associated with disability. Conclu sions-The rise in disability with improved survival was not due to cer ebral palsy; rather the main contributors were blindness due to retino pathy, myopia, and squint. The causes of these disabilities seem to be linked to high CRIB scores. A system of regular and skilled retinal e xamination and access to facilities for retinal ablation should be in place in all neonatal units which undertake the care of such extremely preterm infants.