The New England Journal of Medicine —
August 10, 2000 — Vol. 343, No. 6

Neurologic and Developmental Disability after Extremely Preterm Birth

Nicholas S. Wood, Neil Marlow, Kate Costeloe, Alan T. Gibson, Andrew R. Wilkinson, for the EPICure Study Group

Abstract

Background. Small studies show that many children born as extremely preterm infants have neurologic and developmental disabilities. We evaluated all children who were born at 25 or fewer completed weeks of gestation in the United Kingdom and Ireland from March through December 1995 at the time when they reached a median age of 30 months.

Methods. Each child underwent a formal assessment by an independent examiner. Development was evaluated with use of the Bayley Scales of Infant Development, and neurologic function was assessed by a standardized examination. Disability and severe disability were defined by predetermined criteria.

Results. At a median age of 30 months, corrected for gestational age, 283 (92 percent) of the 308 surviving children were formally assessed. The mean (±SD) scores on the Bayley Mental and Psychomotor Developmental Indexes, referenced to a population mean of 100, were 84±12 and 87±13, respectively. Fifty-three children (19 percent) had severely delayed development (with scores more than 3 SD below the mean), and a further 32 children (11 percent) had scores from 2 SD to 3 SD below the mean. Twenty-eight children (10 percent) had severe neuromotor disability, 7 (2 percent) were blind or perceived light only, and 8 (3 percent) had hearing loss that was uncorrectable or required hearing aids. Overall, 138 children had disability (49 percent; 95 percent confidence interval, 43 to 55 percent), including 64 who met the criteria for severe disability (23 percent; 95 percent confidence interval, 18 to 28 percent). When data from 17 assessments by local pediatricians were included, 155 of the 314 infants discharged (49 percent) had no disability.

Conclusions. Severe disability is common among children born as extremely preterm infants and remains a major challenge in this group of children. (N Engl J Med 2000;343:378-84.)

Source Information

From the School of Human Development, University of Nottingham, Nottingham (N.S.W., N.M.); St. Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, University of London, London (K.C.); Jessop Hospital for Women, Sheffield (A.T.G.); and the Department of Paediatrics, University of Oxford, Oxford (A.R.W.) — all in the United Kingdom. Address reprint requests to Dr. Marlow at the Academic Division of Child Health, Level E East Block, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom, or at neil.marlow@nottingham.ac.uk.

Members of the EPICure Study Group are listed in the Appendix.

Appendix

Members of the EPICure Study Group are as follows: Developmental Panel — A.J. Bennett, M.J. Cruwys, M.C. Dick, S. Egan, A.F. Livingstone, L.J. Logie, R.H. MacGregor, B. Mallya, M.X. Poblete, J.F. Schulte, N.S. Wood, C. Lawson (psychologist), H. Palmer (administrator), and E.M. Hennessy (statistician); Steering Group — P.J. Steer (Chair; London), K. Costeloe (London), A.T. Gibson (Sheffield), I.A. Laing (Edinburgh), M.J. Lewins (Lincoln), N. Marlow (Nottingham), P.O.D. Pharoah (Liverpool), and A.R. Wilkinson (Oxford). The EPICure Study Group also includes the pediatricians in 276 maternity units in the United Kingdom and Ireland who contributed data to the study.

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