Memorandum 53
Supplementary evidence from Professor
John Wyatt
As requested I enclose the abstract referred
to in my oral evidence. For the benefit of the Committee and its
advisors I have also presented summary data abstracted from our
analysis. I have provided the numbers and percentage of infants
born alive at University College London Hospitals who survived
to one year of age. The period of study is 1996 to 2000. The data
have been presented in the form most comparable to the original
EPICURE study. The denominator includes all infants who were born
showing signs of life on labour ward but who died before admission
to the neonatal unit.
| Gestational age (completed weeks)
| Number survived to 1 year of age |
Total born alive at UCLH | Percentage survivors
|
| | |
|
| 22 | 4 | 8 |
50 |
| 23 | 6 | 13
| 46 |
| 24 | 18 | 22
| 82 |
| 25 | 20 | 26
| 77 |
In the time period 1996 to 2000, 26% of survivors within
this gestational age range had evidence of disabling impairments
when examined at one year of age.
A paper enclosing detailed description and analysis of these
data will be submitted for publication in a peer-reviewed scientific
journal shortly.
October 2007
Abstract, European Society for Pediatric Research, Annual
Scientific Meeting 2004
Changes in survival and neurodevelopmental outcome in
22 to 25 week gestation infants over a 20 year period
K J Riley, S Roth, M Sellwood, J S Wyatt Department of
Paediatrics and Child Health, University College London
BACKGROUND
Advances in neonatal care have resulted in the survival of
increasing numbers of extremely preterm infants. There have been
concerns that the improved survival of infants born at the limit
of viability has resulted in infants surviving with significant
disability who would have previously died.
AIMS
To examine the change in survival over a 20 year period of
infants born at less than 26 weeks gestation at a single tertiary
referral centre and to correlate this with neurodevelopmental
outcome at age one year.
METHOD
All infants without major congenital abnormalities born at
less than 26 weeks gestation and admitted to University College
London Hospitals neonatal unit between 1981 and 2000 were prospectively
recruited for long term follow-up. At one year of age corrected
the infants were recalled. Each child underwent a Griffiths Developmental
Assessment and an Amiel-Tison neurological examination. Neurological
status was then classified as normal, impairment without disability
or impairment with disability. The data were divided into five
year blocks for analysis.
RESULTS
A total of 353 infants fulfilled the recruitment criteria
and were enrolled into the study. Of these 190 died and 159 were
recalled at one year of age. Data on four infants was not available.
Survival to one year during the time periods 1981-85, 1986-90,
1991-95 and 1996-2000 was 32%, 34%, 46% and 71% respectively.
The increased survival seen during the 1996-2000 period was statistically
significant using Chi Squared analysis (p = 0.002).
Statistical analysis of the Griffiths results was limited
by modification of the test which resulted in restandardisation
in 1996. This led to an overall reduction in the mean developmental
quotient of 11 points in the normal population. For the infants
in our study the mean total developmental quotient (DQ) during
each of the time periods fell within the normal range. Values
are shown in table 1. Analysis of the sub-scales revealed similar
findings. The incidence of neurodisability was unchanged over
the time periods (p=0.18). See table 1.
Table 1
| Year | Griffiths Total DQ(SD)
| Normal neurodevelopment No (%) |
Impairment without disability No (%) |
Impairment plus disability No (%) |
| 1981-85 | 105.0 (16.6) |
12 (46%) | 9 (35%) | 5 (19%)
|
| 1986-90 | 106.1 (17.6) |
19 (55%) | 7 (21%) | 8 (24%)
|
| 1991-95 | 103.9 (19.2) |
8 (29%) | 9 (32%) | 11 (39%)
|
| 1996-2000 | 94.9 (16.2) |
30 (57%) | 9 (17%) | 14 (26%)
|
CONCLUSIONS
Our data show that despite a significant increase in the
survival of infants born at less than 26 weeks gestation over
a 20 year period there has been no significant increase in the
incidence of adverse neurodevelopmental outcome in survivors.
| 
