Pregnancy should last 9 months, but sometimes it doesn't. With medical advances some babies born as early as 22 or 23 weeks can now survive. Truly miraculous! But how are these extremely preterm babies doing long-term?
A University of Gothenburg study examined this issue by following up on all 383 Swedish children born before 24 weeks (most at 23 weeks) between 2007 to 2018 and who survived. At follow-up the children were between 2 to 13 years of age. The researchers found that almost all of the children had serious long-term problems, whether health or developmental problems.
75% of children born before 24 weeks of gestation had neurodevelopmental disorders, including intellectual disabilities (40%), autism (24%), and 55% required habilitation services. 88% of the group had other physical problems - for example, 63% had asthma and 39% failed to thrive and/or were short for their age. Boys were more likely to have intellectual disabilities and visual impairment than girls.
Looking at the results in the study (see Table 1), it is clear that babies born at 23 weeks had significantly fewer serious problems than at 22 weeks. Every extra week is important!
From Science Daily: Wide-ranging problems in children born before 24 weeks gestation
In a study of children born after a pregnancy of less than 24 weeks, nearly all (96 percent) proved to have any of the diagnoses studied. According to the study, lead from the University of Gothenburg, neuropsychiatric and somatic diagnoses are prevalent as these extremely preterm infants grow into adulthood.
The findings are now published in the scientific journal Acta Paediatrica. The study was based on data in national registers and hospital journals on almost every child born in Sweden in 2007-2018, before the 24th week of gestation, who survived after birth up to what would have been full term (40 weeks).
Altogether, the study comprises 399 children. At follow-up, they were aged 2 to 13 years.
More than half need habilitation
Among these children born before 24 weeks of pregnancy,
- 75 percent had neuropsychiatric impairments, such as some degree of development disorder (40 percent); Attention-Deficit/Hyperactivity Disorder, ADHD (30 percent); and Autism (24 percent).
- 55 percent required habilitation support.
- 88 percent had other medical diagnoses, such as Asthma (63 percent) or postnatal growth restriction (39 percent).
- 17 percent had Cerebral Paresis.
The study shows the marked need for special support for the most immature children, born extremely preterm, and highlights the need for long-term habilitation.
"This is about the tiniest babies born, who wouldn't have survived without modern neonatal care," says Professor Ann Hellström of Sahlgrenska Academy, University of Gothenburg, the last author of the publication.
"Being born extremely preterm has long-term repercussions. Awareness needs to increase for society at large to provide sufficient resources during adolescence and later in life, manage morbidity, structure follow-up programs, and support for disabilities."
Over the past 20 years, the survival rate among extremely premature babies has risen sharply, especially in those born in gestational weeks 22 and 23 . Thus, health care today can save the lives of children born more than four months too early. Enhanced survival has resulted in more knowledge of brain development among these children, and how their cognition, motor skills, hearing, and vision are affected.
This study is the first to provide a comprehensive picture of the prevalence of various diagnoses in the most immature of extremely preterm infants, and the expected substantial impact on the children's lives, in a single nationwide set of research data.
"Doctors and other health professionals need to be aware of the many health and developmental problems that affect these children. Health care services also need resources to identify their long-term treatment and support needs at an early stage," Hellström points out.
The study was conducted in a national collaboration among researchers focusing on newborns (neonatology) and medical conditions relating to the eye (ophthalmology).