Outcome at 5 years of age of children 23 to 27 weeks' gestation: Refining the prognosis

Objectives. To determine the changes with postnatal age for survival, with and without major sensorineural disability, to 5 years of age in very prete rm infants and to contrast their prognosis with normal birth weight (NBW) c ontrol participants. Methods. A geographically determined cohort study was conducted in Victoria , Australia. Consecutive live births of 23 to 27 weeks' gestational age bor n during 1991 to 1992 and randomly selected contemporaneous NBW control par ticipants were studied. The main outcome measures were survival and rates o f major disability at 5 years of age, determined for those offered intensiv e care, after day 7, after day 28, and at hospital discharge. Results. Of 401 live births of 23 to 27 weeks' gestation, 225 (56.1%) survi ved to 5 years of age. The survival rate rose significantly with increasing gestational age at birth in those offered intensive care and by day 7 but not by day 28. The survival rate free of major disability rose significantl y with increasing gestational age at all postnatal ages but was not an inde pendent predictive variable by day 28; other adverse events were more impor tant. In the absence of adverse events, the rate of survival free of major disability for very preterm infants who had survived to discharge was 93.2% , similar to the rate of 95.5% for NBW control participants. Conclusions. The prognosis for very preterm infants changes substantially w ith postnatal age. Counseling of families should be repeated at intervals, and the advice offered should vary with perinatal events.