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Objectives: Survival for births at 22 to 26 weeks gestational age (GA) varies internationally. We investigated the time points at which mortality differences occur using a comparative survival analysis of three population-based national cohorts.

Methods: Fetuses, alive at maternal admission and the onset of labour-monitoring, from EXPRESS (Sweden, 2004-07), EPICure-2 (England, 2006) and EPIPAGE-2 (France, 2011) were included, Terminations of pregnancy and out-of-hospital births were excluded. Results of Kaplan-Meier analyses, stratified by GA (weeks) and censored at postnatal week 16, were compared using the log-rank test at landmark times of birth, 1 hour, 1, 7 and 28 days to explore critical time periods. Hierarchical Cox regression was performed to account for differences in background population and pregnancy characteristics.

Results: Among 840 EXPRESS, 2310 EPICure-2 and 1359 EPIPAGE-2 fetuses included, 16-week survival was respectively 24.5%, 10.8% and 0.5% at 22-23 weeks’ GA; 62.1%, 40.0% and 23.6% at 24 weeks; 74.3%, 64.8% and 56.9% at 25 weeks; and 83.8%, 77.1% and 74.4% at 26 weeks. Early deaths occurred in all cohorts but were most marked in EPIPAGE-2 before 1 day at 22-23 weeks and 24 weeks GA. At 25 weeks, survival varied before 28 days; differences at 26 weeks were minimal. Results from Cox regression were consistent, with survival highest in EXPRESS at all GAs.

Conclusions: Large differences in survival occur during labour and the first hours and days after birth. Early active management is reflected in higher survival at key census points to 16 postnatal weeks in three contemporary national cohorts.

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Background: Postnatal corticosteroids (PNC) have been widely used to prevent bronchopulmonary dysplasia (BPD) in preterm infants despite their potential adverse effects, especially on neurodevelopment. Previous publications hypothesised that death or cerebral palsy in patients treated with PNC would vary with the level of risk for BPD. We aimed to determine whether motor and cognitive development at two years corrected age were improved by steroid treatment in patients at high risk for BPD.

Methods: Infants born between 24⁺⁰ and 29⁺⁶ weeks of gestation in the european EPICE cohort were included. We developed a risk prediction model for BPD to classify our population in three groups of risk for BPD. We compared patients’ neurological outcomes at two years corrected age whether they received PNC treatment or not in each group of risk, using the inverse probability of treatment weighting (IPTW) propensity score method. Both motor and cognitive development outcomes were analysed.

Results: Of 3 662 neonates included in the analysis, 901 (25%) were diagnosed with BPD. Our prediction model for BPD showed good performance for discrimination (c-statistics = 0.82) and for calibration. Postnatal steroids were associated with an increased risk of gross motor impairment at 2 years corrected age (12.10% vs. 5.50% in untreated infants), which was of borderline of significance after IPTW adjustment (OR=1.55, 95% CI, 0.99 to 2.41, p= 0.053). This difference was still observed in the highest BPD risk group with an OR of 1.89 (95% CI 1.07 to 3.33).

Conclusion: Postnatal steroids remain associated with gross motor impairment regardless of the risk for BPD.

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Background: Early hypocapnia in preterm infants is associated with intraventricular haemorrhage (IVH) and increased bronchopulmonary dysplasia (BPD). Volume guarantee ventilation (VGV) has been shown to reduce hypocapnia in moderately preterm infants, but less is reported of infants born at 22-25 weeks’ gestational age (wGA).

Aims: To investigate short and long term benefits of early VG on incidence of hypocapnia, IVH and BPD in extremely preterm born infants.

Methods: A retrospective observational study of infants born 22-25 wGA in need of mechanical ventilation on the first day of life, comparing VGV with assist control (A/C) ventilation. Ventilatory data was collected at admission and every four-hour during the first day of life together with blood gases, perinatal characteristics and outcomes.

Results: 104 infants were included (mean GA 24⁺⁰± 1⁺¹wks; birth weight 619±146 g). Positive inspiratory pressure (PIP) was lower in the VG-group (n=44) than in the A/C-group (n=60) at 4, 8, 12, 16, and 20 hours (p<.05), without any differences in positive end-expiratory pressure, respiratory rate or FiO2. Incidence of hypocarbia (<4.5 kPa) was lower with VG than AC (32% vs 64%, p < .01). At 24 hours, infants in the VG-group were more frequently extubated (30 vs 13%, p < .05). IVH grade ≥3, duration of mechanical ventilation and BPD did not differ between the groups.

Conclusions: Volume Guarantee Ventilation is safe to apply in infants born between 22-25 wGA, and was observed to have lower PIP and less episodes of hypocapnia compared to A/C.