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More babies survive before 27 weeks, but severe disability rates unchanged
The number of babies born before 27 weeks’ gestation who survive and leave hospital increased between 1995 and 2006, but the proportion who experience serious health problems into childhood remained largely unchanged, according to new research published in the British Medical Journal.
Two papers from the EPICure cohorts suggest that while the number of very pre-term babies who survive may continue to rise, it is likely that the number of children and adults with long-term disability caused by complications of premature birth will rise in parallel.
Babies born before 27 weeks face a battle for survival and many go on to live with long-term health problems such as lung conditions, learning difficulties and cerebral palsy. The rates of premature birth are on the rise in many European countries and are particularly high in the UK.
The two studies were funded by the Medical Research Council (MRC) and led by UCL and Queen Mary, University of London. They compared a group of babies born between 22-26 weeks’ gestation in 2006 with those born between 22-25 weeks over a 10-month period in 1995.
Our findings show that more babies now survive being born too soon than ever before, which is testament to the highly-skilled and dedicated staff in our neonatal services. But as the number of children that survive pre-term birth continues to rise, so will the number who experience disability throughout their lives.
Professor Neil Marlow, UCL Institute for Women's Health
The first looked at immediate survival rates and health of extremely pre-term babies born in 2006 (until they went home from hospital) and compared these with the same measures taken in 1995.
It found that the number of babies born at 22-25 weeks and admitted to intensive care increased by 44 per cent during this period and overall survival increased by 13 per cent (from 40 to 53 per cent). There was no significant increase in survival of babies born before 24 weeks – the current legal limit for abortion – and the number of babies who experienced major health complications remained unchanged.
The second study examined the health of the 2006 babies at three years of age and compared this with findings from the 1995 cohort at a similar age. It found that while 11 per cent more babies survived to age three without disability, the proportion of survivors born between 22–25 weeks with severe disability was about the same (18 per cent in 1995 and 19 per cent in 2006).
There was also a relationship between gestation and the risk of disability, with babies born earlier being more likely to have serious health complications at three years of age.
Professor Neil Marlow, an MRC-funded researcher at the UCL Institute for Women’s Health and an author on both papers, said: “Our findings show that more babies now survive being born too soon than ever before, which is testament to the highly-skilled and dedicated staff in our neonatal services. But as the number of children that survive pre-term birth continues to rise, so will the number who experience disability throughout their lives. This is likely to have an impact on the demand for health, education and social care services.”
Study author Professor Kate Costeloe, from Queen Mary, University of London and Homerton University Hospital, said: “This research shows that while we still have some way to go in improving the outlook for extremely premature babies, we’re definitely moving in the right direction. The similarities between two sets of children born 11 years apart also indicate that continuing to follow the older children as they grow will give us important information about the outlook for premature babies born today and in the future. This will help to ensure these babies get the best possible care at birth and throughout their development.”
Professor David Lomas, Chair of the MRC’s Population and Systems Medicine Board, which funded the two EPICure cohorts, added: “Almost half of babies born before 27 weeks will now pull through and while many go on to do very well in the long term, a significant proportion will continue to need support throughout their lives to deal with the complications of their early arrival. Studies like EPICure are a very powerful tool as they allow us to follow the health of a distinct population over a long period of time, informing future treatment strategies that improve the lives of patients.”
The EPICure study recorded all babies born between 22-25 weeks gestation at every maternity unit in the UK and the Republic of Ireland for 10 months in 1995.
EPICure 2 was set up to follow a new group of extremely premature babies born between 22-26 weeks in England in 2006 to see how things had moved on since then, and to revisit the children born in 1995 to assess their long-term health.
Media contact: Dave Weston
Image caption: Premature baby in intensive care, courtesy of kqedquest on Flickr