Health Outcomes at 2 Years Corrected Age: RGH NICU Graduate Cohort

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Presentation transcript:

Health Outcomes at 2 Years Corrected Age: RGH NICU Graduate Cohort 2007-2011 A W Allman Sept 2014

Background and Context BAPM/RCPCH working group “Classification of health status at 2 years as a perinatal outcome” Marlow et al 2008 Recommended FU at corrected age of 2 years for all infants <32 weeks or <1500g Standardised outcome data “Working group recommends all neonatal services plan to develop their follow up service to include a formal assessment using the Bayley III developmental scale”

The Team Dr AA Dr Sarmistha Maity Sr Becky Graves Sr Lisa Jones Babies < 32 weeks who have received intensive care at RGH Bayley’s assessment and HSQ Serennu, NHH, community Babies born from 2007

Health Status at 2 Years Severe neurodevelopmental disability (SND) CP GMFCS level 3,4,5 Cognitive function <-3 SD below norm Hearing – nil SAL – no words Vision - blind Moderate neurodevelopmental disability (MND) CP GMFCS level 2 Cognitive function -2SD to -3SD below norm Hearing loss, aided SAL < 5 words Vision – mod reduced

Summary Outcomes Outcome 2007-2011 Number (%) Admitted for intensive care 368 Survived to discharge 328 Survived to 2yrs CGA 318 (86%) Information available 155 (49%) Death or disability (MND and SND) at 2 yrs CGA (% admitted for intensive care) 87 (24%) Total disability at 2 yrs CGA (% of children assessed) 37 out of 155 (24%) (76% disability free) MND (% children assessed) 32 out of 155 (21%) SND (% children assessed) 5 out of 155 (3%) Survival free of ND impairment (% children assessed) 118 out of 155 (76%)

Survival at 2 Years by Gestation

Death or Disability of those admitted to NNU – by gestation

Disability in Survivors Assessed n=155 (49%)

Disability in survivors assessed by gestation

Pattern of disability at 2 years

Cumulative outcome Extreme prematurity (22-25 weeks) Number (%) Admitted for intensive care 53 Survived to discharge 32 (60%) Survived at 2 yrs CGA 26 (49%) Information available 14 (54%) Death or disability (MND+SND) at 2 yrs CGA (% admitted for intensive care) 31 (58%) Total disability at 2 yrs CGA (% of children assessed) 5 (36%) Moderate neurodevelopmental disability (MND) (% of children assessed) 4 (29%) Severe neurodevelopmental disability (SND) (% of children assessed) 1 (7%) Survival free of neurodevelopmental impairment (% of children assessed) 9 (64%)

Outcomes in survivors assessed (extreme prematurity) n=14

Conclusions <32 weeks RGH 5 year cohort 2007-2011 86% of infants admitted survived to 2 yrs Health outcome available in 49% of survivors, all through standardised assessment Combined death or disability was 24% 76% of survivors assessed were free of moderate to severe disability Serious visual impairment was rare

Conclusions Data comparable to major studies BUT BEWARE Small numbers 51% of survivors not assessed