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, François Goffinet, Pierre Kuhn, Bruno Langer, Jacqueline Matis, Xavier Hernandorena, Pierre Chabanier, Laurence Joly-Pedespan, Bénédicte Lecomte, Françoise Vendittelli, Michel Dreyfus, Bernard Guillois, Antoine Burguet, Pierre Sagot, Jacques Sizun, Alain Beuchée, Florence Rouget, Amélie Favreau, Elie Saliba, Nathalie Bednarek, Patrice Morville, Gérard Thiriez, Loïc Marpeau, Stéphane Marret, Gilles Kayem, Xavier Durrmeyer, Michèle Granier, Olivier Baud, Pierre-Henri Jarreau, Delphine Mitanchez, Pascal Boileau, Pierre Boulot, Gilles Cambonie, Hubert Daudé, Antoine Bédu, Fabienne Mons, Jeanne Fresson, Rachel Vieux, Corine Alberge, Catherine Alberge, Catherine Arnaud, Christophe Vayssière, Patrick Truffert, Véronique Pierrat, Damien Subtil, Claude D'Ercole, Catherine Gire, Umberto Simeoni, André Bongain, Loïc Sentilhes, Jean-Christophe Rozé, Jean Gondry, André Leke, Michel Deiber, Olivier Claris, Jean-Charles Picaud, Anne Ego, Thierry Debillon, Anne Poulichet, Eliane Coliné, Anne Favre, Olivier Fléchelles, Sylvain Samperiz, Duksha Ramful, Bernard Branger, Valérie Benhammou, Laurence Foix-L'Hélias, Laetitia Marchand-Martin, Monique Kaminski
JAMA Pediatrics 2015, 169 (3): 230-8

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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