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Survival and Morbidity of Preterm Children Born at 22 Through 34 Weeks’ Gestation in France in 2011

Pierre-Yves Ancel 1 François Goffinet 1 Pierre Kuhn Bruno Langer 2 Jacqueline Matis Xavier Hernandorena Pierre Chabanier 3 Laurence Joly-Pedespan Bénédicte Lecomte Françoise Vendittelli 4 Michel Dreyfus 5 Bernard Guillois 6 Antoine Burguet 1 Pierre Sagot 7 Jacques Sizun 8 Alain Beuchée 9, 10 Florence Rouget 11, 10 Amélie Favreau Elie Saliba 12 Nathalie Bednarek 13 Patrice Morville 14 Gérard Thiriez 15 Loïc Marpeau 5 Stéphane Marret 16, 17 Gilles Kayem 18 Xavier Durrmeyer 19 Michèle Granier 20 Olivier Baud 21 Pierre-Henri Jarreau 22 Delphine Mitanchez 23 Pascal Boileau 24 Pierre Boulot 25 Gilles Cambonie 26 Hubert Daudé 27 Antoine Bédu 28 Fabienne Mons Jeanne Fresson 29 Rachel Vieux 30 Catherine Alberge Catherine Arnaud 31 Christophe Vayssiere 32 Patrick Truffert 1 Véronique Pierrat 1 Damien Subtil 33 Claude D’ercole Catherine Gire 34 Umberto Siméoni 35 André Bongain 36 Loïc Sentilhes 37 Jean-Christophe Roze 38 Jean Gondry 39 Andre Leke 40 Michel Deiber Olivier Claris 41 Jean-Charles Picaud 42 Anne Ego 33 Thierry Debillon 43 Anne Poulichet Eliane Coliné Anne Favre 44 Olivier Fléchelles Sylvain Samperiz 45 Duksha Ramful 45 Bernard Branger 46 Valérie Benhammou 47 Laurence Foix-L’hélias Laetitia Marchand-Martin 48 Monique Kaminski 1
16 Team 4 "NeoVasc" - INSERM U1245
GPMCND - Génomique et Médecine Personnalisée du Cancer et des Maladies Neuropsychiatriques
48 CRESS - U1153 - Equipe 1 : EPOPé - Épidémiologie Obstétricale, Périnatale et Pédiatrique
UPD5 - Université Paris Descartes - Paris 5, CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
Abstract : Importance Up-to-date estimates of the health outcomes of preterm children are needed for assessing perinatal care, informing parents, making decisions about care, and providing evidence for clinical guidelines. Objectives To determine survival and neonatal morbidity of infants born from 22 through 34 completed weeks’ gestation in France in 2011 and compare these outcomes with a comparable cohort in 1997. Design, Setting, and Participants The EPIPAGE-2 study is a national, prospective, population-based cohort study conducted in all maternity and neonatal units in France in 2011. A total of 2205 births (stillbirths and live births) and terminations of pregnancy at 22 through 26 weeks’ gestation, 3257 at 27 through 31 weeks, and 1234 at 32 through 34 weeks were studied. Cohort data were collected from January 1 through December 31, 1997, and from March 28 through December 31, 2011. Analyses for 1997 were run for the entire year and then separately for April to December; the rates for survival and morbidities did not differ. Data are therefore presented for the whole year in 1997 and the 8-month and 6-month periods in 2011. Main Outcomes and Measures Survival to discharge and survival without any of the following adverse outcomes: grade III or IV intraventricular hemorrhage, cystic periventricular leukomalacia, severe bronchopulmonary dysplasia, retinopathy of prematurity (stage 3 or higher), or necrotizing enterocolitis (stages 2-3). Results A total of 0.7% of infants born before 24 weeks’ gestation survived to discharge: 31.2% of those born at 24 weeks, 59.1% at 25 weeks, and 75.3% at 26 weeks. Survival rates were 93.6% at 27 through 31 weeks and 98.9% at 32 through 34 weeks. Infants discharged home without severe neonatal morbidity represented 0% at 23 weeks, 11.6% at 24 weeks, 30.0% at 25 weeks, 47.5% at 26 weeks, 81.3% at 27 through 31 weeks, and 96.8% at 32 through 34 weeks. Compared with 1997, the proportion of infants surviving without severe morbidity in 2011 increased by 14.4% (P < .001) at 25 through 29 weeks and 6% (P < .001) at 30 through 31 weeks but did not change appreciably for those born at less than 25 weeks. The rates of antenatal corticosteroid use, induced preterm deliveries, cesarean deliveries, and surfactant use increased significantly in all gestational-age groups, except at 22 through 23 weeks. Conclusions and Relevance The substantial improvement in survival in France for newborns born at 25 through 31 weeks’ gestation was accompanied by an important reduction in severe morbidity, but survival remained rare before 25 weeks. Although improvement in survival at extremely low gestational age may be possible, its effect on long-term outcomes requires further studies. The long-term results of the EPIPAGE-2 study will be informative in this regard.
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Submitted on : Friday, January 31, 2020 - 11:46:41 AM
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Pierre-Yves Ancel, François Goffinet, Pierre Kuhn, Bruno Langer, Jacqueline Matis, et al.. Survival and Morbidity of Preterm Children Born at 22 Through 34 Weeks’ Gestation in France in 2011. Medicine Archives of Pediatrics & Adolescent - JAMA Pediatrics , American Medical Association - JAMA Network, 2015, 169 (3), pp.230. ⟨10.1001/jamapediatrics.2014.3351⟩. ⟨hal-02462370⟩

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