3-Year Survival and Neurodevelopmental Outcomes in Extremely Premature Neonates: A 15-Year Odyssey
Notice bibliographique
Résumé
Abstract BACKGROUND: For neonates born at limits of viability, CPS recommends resuscitation decisions should occur after detailed discussion with parents, utilizing best available data on survival and neuro-developmental morbidities. There are emerging studies reporting such outcomes beyond 18-24 months. However, there is a notably wide variation in survival and rates of long term morbidity reported in the literature for infants born before 26 weeks of gestation. Centre specific survival rates among actively resuscitated extremely premature neonates and accurate developmental outcome data that truly reflects functional abilities are crucial for both parents and healthcare providers. OBJECTIVES: Assess mortality, neuro-developmental outcomes at 3 years of age and correlate with risk factors predictive of adverse developmental outcomes in neonates born between 23+0-26+6 weeks of gestation at a tertiary care center in Ontario, Canada DESIGN/METHODS: This was a retrospective analysis at a Level 3 center focusing on neonates born at 23+0 to 26+ 6 weeks gestation between January 2000 to December 2014. Data was extracted from Neonatal-Perinatal Database and Developmental Clinic Database. Clinical assessment of motor impairment (GMFCS), sensory impairment(blind or deaf) and a well validated tool Child Development Inventory were used to assess developmental outcomes at 3 yrs of age. Comparative analysis of possible risk factors, extracted from the NICU database , for adverse outcomes were analyzed using multivariate regression. RESULTS: Survival rate among actively treated neonates were 25%, 60.4% and 77.5% at 23, 24 and 25 weeks respectively. 3 year survival rates with no major motor or neuro-sensory impairment were 40% among survivors born at 23 weeks, 47.2% among those born at 24 weeks, 55.6% and 68.6% among those born at 25 and 26 weeks respectively. Those born at 23 weeks had a significantly higher risk of having CP compared to the risk at 26 weeks [OR 9.04 {CI 1.96-41.67}]. Presence of IVH [OR 2.50 {CI 1.20-5.21}] and CSF infections [OR 5.71 {CI 1.03-31.56}] were identified as significant risk factors for adverse motor outcomes. Female neonates across all gestational age groups had significantly lower C P, speech delay and significantly better CDI scores. CDI profile analysis showed that at 3 years, nearly 80% of neonates born between 24-26 weeks have normal General Development Score, while only 40% of neonates born at 23 weeks had normal General Development Score at 3 years. CONCLUSION: Being born at 23 week increased risk of cerebral palsy when compared to risk of birth at 26 weeks. CSF infection and IVH were found to be significant risk factors for adverse motor outcomes. The functional abilities as per the CDI Profiles were remarkably similar among survivors born at 24, 25,26 weeks of gestation.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».