3-Year Survival and Neurodevelopmental Outcomes in Extremely Premature Neonates: A 15-Year Odyssey
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".