Survival and morbidity of preterm children born at 22 through 34 weeks' gestation in France in 2011: results of the EPIPAGE-2 cohort study.

Pierre-Yves Ancel 1 François Goffinet 2, 3 Pierre Kuhn 4 Bruno Langer 5 Jacqueline Matis Xavier Hernandorena Pierre Chabanier 6, 7 Laurence Joly-Pedespan Bénédicte Lecomte Françoise Vendittelli 8 Michel Dreyfus 9 Bernard Guillois Antoine Burguet 10, 11 Pierre Sagot 12, 13 Jacques Sizun 14 Alain Beuchée 15 Florence Rouget 16 Amélie Favreau 17 Elie Saliba Nathalie Bednarek 18 Patrice Morville 19 Gérard Thiriez 20 Loïc Marpeau 21 Stéphane Marret 22, 23 Gilles Kayem 24 Xavier Durrmeyer 1 Michèle Granier 25 Olivier Baud Pierre-Henri Jarreau 26, 27 Delphine Mitanchez Pascal Boileau 28, 29 Pierre Boulot 30 Gilles Cambonie 31 Hubert Daudé 32 Antoine Bédu 33 Fabienne Mons Jeanne Fresson 34, 35 Rachel Vieux 36 Corine Alberge Catherine Alberge Catherine Arnaud Christophe Vayssière 37 Patrick Truffert 38, 39 Véronique Pierrat 3, 40 Damien Subtil 41 Claude D'Ercole 42 Catherine Gire Umberto Simeoni 43, 44 André Bongain 45 Loïc Sentilhes 46 Jean-Christophe Rozé Jean Gondry André Leke Michel Deiber Olivier Claris 47 Jean-Charles Picaud Anne Ego 3, 48, 49 Thierry Debillon 50 Anne Poulichet Eliane Coliné Anne Favre Olivier Fléchelles Sylvain Samperiz 51 Duksha Ramful 52 Bernard Branger Valérie Benhammou Laurence Foix-L'Hélias 3 Laetitia Marchand-Martin 3 Monique Kaminski 1
1 CRESS (U1153 / UMR_A 1125) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
2 Service de Gynécologie et Obstétrique [Cochin]
3 UMR_S 953 - Recherche Epidémiologique en Santé Périnatale et Santé des Femmes et des Enfants
4 LINC - Laboratoire d'Imagerie et de Neurosciences Cognitives
5 Service de gynécologie–obstétrique
6 Centre de compétences des microangiopathies thrombotiques
7 pôle gynécologie-obstétrique et médecine foetale
8 PEPRADE - Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement
9 Clinatec - Centre de recherche biomédicale Edmond J.Safra
10 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
11 CIC-EC - Centre d'Investigation Clinique 1432 (Dijon) - Epidemiologie Clinique/Essais Cliniques
12 Service de Gynécologie Obstétrique, Médecine Foetale et Stérilité Conjugale - Chirurgie Gynécologie et Oncologique [CHU de Dijon]
13 CEP - Centre d'épidémiologie des populations
14 LCE - Laboratoire Chrono-environnement - UFC (UMR 6249)
15 Centre Hospitalier Universitaire de Rennes
16 Irset - Institut de recherche, santé, environnement et travail
17 PRC - Physiologie de la reproduction et des comportements [Nouzilly]
18 URCA - Université de Reims Champagne-Ardenne
19 Service de cardiologie pédiatrique
20 Service Pédiatrique
21 Service de gynécologie-obstétrique [Caen]
22 Service de pédiatrie néonatale et réanimation - neuropédiatrie [Rouen]
23 Néovasc - Endothélium microcirculatoire cérébral et lésions du système nerveux central au cours du développement
24 Service de Gynécologie-Obstétrique [Colombes]
25 Médecine néonatale
26 PremUp Foundation
27 Maternité Port-Royal [CHU Cochin]
28 Assistance Publique - Hôpitaux de Paris
29 UPD5 - Université Paris Descartes - Paris 5
30 Gynéco-Obstétrique
31 IBMM - Institut des Biomolécules Max Mousseron [Pôle Chimie Balard]
32 AMU - Aix Marseille Université
33 Service de Pédiatrie médicale - réanimation et néonatologie [CHU Limoges]
34 Comité consultatif sur le traitement de l'information en matière de recherche dans le domaine de la santé
35 Service d'Epidémiologie
36 LaBRI - Laboratoire Bordelais de Recherche en Informatique
37 Épidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps
38 Unité de Néonatalogie
39 Unité de Recherche Epidémiologique sur la Qualité des Soins
40 Service de Médecine Néonatale
41 Département d'obstétrique[Lille]
42 Service d'Obstétrique-Gynécologie [Marseille]
43 VRCM - Vascular research center of Marseille
44 Service de Médecine Néonatale
45 Service de Gynécologie - Obstétrique, Reproduction et de Médecine f½tale
46 Service de gynécologie-obstétrique [Angers]
47 SIS - Santé Individu Société - SIS
48 Registre des Handicaps de l'Enfant et Observatoire Périnatal Isère
49 DMIS
50 Médecine Néonatale et Réanimation Pédiatrique CHU Grenoble
51 Centre Hospitalier Félix-Guyon
52 Université de Maurice
Abstract : 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. 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. 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. 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). 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. 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.
Keywords : gestational age infant mortality infant premature pregnancy outcome pregnancy survival analysis morbidity premature birth birth
Type de document :
Article dans une revue
JAMA pediatrics, 2015, 169 (3), pp.230-8. 〈10.1001/jamapediatrics.2014.3351〉
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http://hal.univ-brest.fr/hal-01258705
Contributeur : Ghislaine Calvez <>
Soumis le : mardi 19 janvier 2016 - 13:30:33
Dernière modification le : jeudi 13 septembre 2018 - 09:28:03

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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: results of the EPIPAGE-2 cohort study.. JAMA pediatrics, 2015, 169 (3), pp.230-8. 〈10.1001/jamapediatrics.2014.3351〉. 〈hal-01258705〉

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