Resultats del programa de seguiment dels nadons prematurs extrems nascuts en els límits de la viabilitat de 24 i 25 setmanes d’edat gestacional / Results of the follow-up program of extremely preterm infants born at limits of viability (24 and 25 weeks of gestational age)

Fonament. Els avenços perinatològics han suposat unincrement de la supervivència dels prematurs extrems,amb una progressiva disminució dels límits de la viabilitat.Objectiu. Conèixer els resultats del seguiment dels nadons«fetals».Mètode. Han estat avaluats tots els supervivents de 24i 25 setmanes (s) d’edat gestacional que van ser donatsd’alta des de l’1 de juny de 1998 i que tenen al menys 12mesos d’edat corregida: 45 nens (14 de 24 s i 31 de 25 s).Resultats. Desenvolupament motor: normal en el 50%de 24 s i en el 78.6% de 25 s; retard motor simple en el 33%i en el 14.2%, respectivament; paràlisi cerebral en el 16%de 24 s (2 nens, 1 diplegia, 1 tetraplegia espàstica, tots dosgreus) i en el 7.1% de 25 s (2 nens, 1 moderada, 1 greu).Desenvolupament cognitiu: normal en el 25% de 24 s ien el 64.2% de 25 s; retard lleu en el 50% i en el 28.5%; retardmoderat-greu en el 25% i en el 7.1%, respectivament.Desenvolupament sensorial: visió normal en el 41.6%de 24 s i en el 64,2% de 25 s; alteracions lleus: 41.6% i32.1%; afectació greu: 16.6% i 3.6% respectivament.Seqüeles globals: en els nascuts a les 24 s: 0% lliures deseqüeles, 58.3% lleus, 16.6% moderades, 25% seqüelesgreus; en els nascuts a les 25 s: 32,1% sense seqüeles,53.6% lleus, 7.1% moderades, 7.1% seqüeles greus.Pèrdua de seguiment: 5 nens (11%).Conclusions. En la nostra població de supervivents enels límits de la viabilitat hi ha un risc de seqüeles elevat, toti que la majoria són lleus. És imprescindible continuar ambel seguiment per avaluar les conseqüències de la prematuritatextrema a llarg termini

Background. Modern obstetric and neonatal care haveincreased the survival of the extremely preterm neonates.As the limits of viability decrease, it is of paramount importanceto have reliable data on long-term morbidity.Objectives. To study the outcome of fetal infantsMethods. All surviving children of 24 and 25 weeks ofgestational age (GA) discharged from a single hospitalsince June 1st 1998, and who were at least 12 months of corrected age, were evaluated in this retrospective study.A total of 45 infants (GA 24 weeks, 14; GA 25 weeks, 31)were included.Results. Five children were lost to follow-up. Motor Development:Normal in 50% and 78.6 of GA 24 and 25 weeksinfants, respectively; mild motor delay in 33% and14.2% of GA 24 and 25 weeks, respectively; cerebral palsyin 16% of GA 24 weeks (2 children: 1 diplegia, and 1 spastictetraplegia, both severe), and 7.1% of GA 25 weeks (2children: 1 moderate and 1 severe).Cognitive development: Normal in 25% and 64.2% ofGA 24 and 25 weeks, respectively; mild delay in 50% and28.5% of GA 24 and 25 weeks, respectively; moderate tosevere delay in 25% and 7.1% of GA 24 and 25 weeks,respectively.Visual development: Normal vision in 41.6% and64.2% of GA 24 and 25 weeks, respectively; mild deficits in41.6% and 32.1% of GA 24 and 25 weeks, respectively;severe deficits in 16.6% and 3.6% of GA 24 and 25 weeks,respectively.Global impairment: In the GA 24 weeks infants, nonewere free of disabilities, 58.3% were considered to havemild sequelae, 16.6% had moderate sequelae, and 25%had severe sequelae. In the GA 25 weeks infants, 32.1% hadno disabilities, and 53.6%, 7.1%, and 7.1% were consideredto have mild, moderate, and severe sequelae, respectively.Conclusions. Newborns at the threshold of viabilityhave a high risk of developing disabilities, although inmost cases the impairments are mild. Continued follow-upinto late childhood is needed to evaluate long-term effects of extreme prematurity