Ahead of their timeBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3900 (Published 17 August 2017) Cite this as: BMJ 2017;358:j3900
The arrival of a newborn is usually a time of excitement and happiness, accompanied by a healthy degree of trepidation about what lies ahead. But for parents or carers of preterm babies feelings of fear and anxiety may predominate.
In England and Wales around one in 13 babies is born preterm and one in 250 extremely preterm (before 28 weeks). In 2015 this amounted to 53 209 preterm and 3014 extremely preterm babies (Office for National Statistics http://bit.ly/2vFagTL). Neonatal medicine has achieved big improvements in mortality over the past few decades, but developmental morbidity remains a concern. For parents, discussions about developmental uncertainty begin early. These conversations weigh heavily, paving the way for anxious anticipation of every milestone and a tendency to benchmark your child against others.
The best information about developmental risk comes from robust cohort studies, such as EPICure (doi:10.1136/bmj.e7961), which report key clinical and developmental outcomes. But these have tended to look only at the extremes of preterm birth, limiting their relevance to babies born very and moderately preterm (27-34 weeks), who make up the majority of early deliveries. This week in The BMJ a study by Véronique Pierrat and colleagues looks at the changing patterns of morbidity in babies born in France in 1997 and 2011 at 22-34 weeks gestation, followed up at 2 years of age (doi:10.1136/bmj.j3448).
For children born at 22-31 weeks’ gestation, those 14 years between the two groups brought improvements in overall survival and in survival without severe or moderate disability. A statistically significant decrease in cerebral palsy was also noted in the 24-31 and 32-34 weeks’ gestation groups. This is encouraging. But developmental delay remained common, even in babies born moderately preterm. Socioeconomic status and being small for gestational age were the main factors associated with lower developmental scores. The authors say these factors should be considered when planning follow-up.
How then should we follow up children and young people who are born prematurely? Our NICE guideline summary (doi:10.1136/bmj.j3514) offers an approach, and we have added a handy infographic to help you navigate the recommendations for the different risk groups. Important take-home messages are to acknowledge the strain imposed by the situation, consider the individual needs of the family, and encourage parents to report concerns early, because behind every preterm baby is a family faced with a childhood of uncertainty.