OUTCOME AT 2 YEARS OF CHILDREN 23-27 WEEKS GESTATION BORN IN VICTORIAIN 1991-92

Objective: To determine the survival and sensorineural disability rate s in very preterm infants born in 1991-92, and to compare the results with contemporaneous normal birthweight controls and with preterm infa nts born in 1985-87. Methodology: This was a geographically determined cohort study in the state of Victoria, Australia of consecutive liveb irths 23-27 weeks' gestational age born during 1991-92, and randomly s elected contemporaneous normal birthweight (NBW) controls born during 1991-92 in the three level-ill perinatal centres in the State. Consecu tive livebirths 24-26 weeks gestational age born in the State during 1 985-87 comprised another comparison group. The main outcome measures w ere survival and sensorineural disability rates at 2 years of age. Res ults: Of the 401 livebirths 23-27 weeks in 1991-92, 225 (56.1%) surviv ed to 2 years of age. The survival rate for those 24-26 weeks was 57.4 % (143/249), a statistically significant increase on the regional surv ival rate of 30.1% (95/316) in 1985-87. In 1991-92 births, the surviva l rate rose significantly with increasing gestational age, and was sig nificantly higher than in 1985-87 at each of 24, 25, and 26 weeks. Of sensorineural impairments in preterm survivors at 2 years of age, the rate of blindness was significantly lower in 1991-92 (2.3%) compared w ith 1985-87 (8.4%), and the overall rates of sensorineural disability were not statistically different in 1991-92 compared with 1985-87. In 1991-92 preterm survivors, the survival rate free of disability rose s ignificantly with increasing gestational age, and as a percentage of s urvivors the rate of disability overall fell with increasing gestation al age. However, the rate of disability overall was much higher in pre term infants than NBW controls.Conclusions: Survival rates of very pre term infants in this regional cohort have improved in the 1990s after the introduction of exogenous surfactant. Blindness at 2 years of age was significantly lower than in an earlier preterm cohort, but the rat es of sensorineural disability still remain higher in very preterm sur vivors than for NBW controls. Although survival rates are lower and di sability rates are higher with diminishing maturity, there is no obvio us gestational age below which adverse neurological outcome in survivo rs would preclude active management on the basis of gestational age al one.