No change in neurodevelopment at 11-years after extremely preterm birth

Objective: To determine whether improvements in school age outcomes had occurred between two cohorts of births at 22 to 25 weeks of gestation to women resident in England in 1995 and 2006.Design: Longitudinal national cohort studies.Setting: School or home-based assessments at 11 years of age.Participants: EPICure2 cohort of births at 22-26 weeks of gestation in England during 2006: a sample of 200 of 1031 survivors were evaluated; outcomes for 112 children born at 22-25 weeks’ gestation were compared to those of 176 born in England during 1995 from the EPICure cohort. Classroom controls for each group acted as a reference population. Main outcome measures: Standardised measures of cognition and academic attainment were combined with parent report of other impairments to estimate overall neurodevelopmental status.Results: At 11 years in EPICure2, 18% had severe and 20% moderate impairments. Comparing births at 22-25 weeks in EPICure2 (n=112), 26% had severe and 21% moderate impairment compared to 18% and 32% respectively in EPICure. After adjustment, the odds ratio of moderate or severe neurodevelopmental impairment in 2006 compared to 1995 was 0.76, 95%CI 0.45, 1.31; p=.32. IQ scores were similar in 1995 (mean 82.7; SD 18.4) and 2006 (81.4; SD 19.2), adjusted difference in mean z-scores 0.2SD (95%CI -0.2, 0.6), as were attainment test scores. The use of multiple imputation did not alter these findings.Conclusion: Improvements in care and survival between 1995 and 2006 are not paralleled by improved cognitive or educational outcomes or a reduced rate of neurodevelopmental impairment.