Survival and neurodevelopmental morbidity at 1 year of age following extremely preterm delivery over a 20-year period: a single centre cohort study.

AIM: To assess survival and neurodevelopmental outcome of extremely preterm infants over a 20-year period at a single tertiary neonatal centre. METHODS: All infants between 22 and 25(+6) weeks of gestation admitted to a single UK neonatal centre between 1981 and 2000 were enrolled prospectively. Infants in the same gestational age range who were born alive at the hospital but not admitted to the neonatal unit were also identified over the period 1991-2000. All surviving infants received neurological and developmental assessment at a corrected age of 1 year. RESULTS: There was a progressive increase in survival at all gestational ages over the 20-year period. Overall survival rose from 32% to 71% as a proportion of all admissions. The proportion of survivors with adverse neurodevelopmental outcome at 1 year of age showed no consistent change over the same period. CONCLUSION: In this single centre cohort study, marked improvements in survival over a 20-year period were not accompanied by a significant increase in neurodevelopmental morbidity.

Postnatal adaptation of cerebral blood flow using near infrared spectroscopy in extremely preterm infants undergoing high-frequency oscillatory ventilation.

AIM: To determine cerebral blood flow using near infrared spectroscopy in extremely preterm infants undergoing high-frequency oscillatory ventilation during the first three days of life. Low cerebral blood flow has been associated with both intra-ventricular haemorrhage and periventricular leucomalacia. It is well established that cerebral blood flow increases over the first three days of life in extremely preterm infants who are conventionally ventilated with intermittent positive pressure ventilation. However, there is no information about cerebral blood flow in preterm babies undergoing high-frequency oscillatory ventilation. In addition, there are concerns that high-frequency oscillatory ventilation may be associated with an increased incidence of intra-ventricular haemorrhage in premature infants. METHODS: Thirteen appropriately grown, preterm infants of less than 28 wk gestation who were admitted to the neonatal unit at University College Hospital, London were studied using near infrared spectroscopy. Left ventricular output and right ventricular output were assessed echocardiographically. RESULTS: Extremely preterm infants undergoing high-frequency oscillatory ventilation have remarkably low cerebral blood flow in the first 12 h of life, median 6.7 (range 4.4-11) mls. 100 g(-1) min(-1) followed by an increase over the subsequent three days. Left ventricular output also increased over the first three days of life, whereas right ventricular output showed no clear relationship with time. Despite low cerebral blood flow only one infant had evidence of major cerebral injury. CONCLUSION: Cerebral blood flow is extremely low in this group of preterm babies. Despite this extremely low cerebral blood flow, the clinical outcome is good. There was an increase in cerebral blood flow and a corresponding increase in left ventricular output over the first few days of life.

Transposition of the great arteries, ventricular septal defect and diaphragmatic hernia in a fetus: the role of prenatal diagnosis in helping to predict postnatal survival.

Congenital heart disease and congenital diaphragmatic hernia are frequently associated. The combination of these lesions is predictive of poor postnatal survival. The identification of both lesions during prenatal life may facilitate improved survival in carefully selected cases. We present a case of left-sided diaphragmatic hernia with transposition of the great arteries and a ventricular septal defect (VSD) that survived following repair of both defects within the first six weeks of life.