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
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.
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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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