Despite providing intensive care to more infants born <24 weeks’ gestation, data on school-age outcomes, critical for counselling and decision-making, are sparse. Objective To compare major neurosensory, cognitive and academic impairment among school-aged children born extremely preterm at 22–23 weeks’ gestation (EP22–23) with those born 24–25 weeks (EP24–25), 26–27 weeks (EP26–27) and term (≥37 weeks). Design Three prospective longitudinal cohorts. Setting Victoria, Australia. Participants All EP live births (22–27 weeks) and term-born controls born in 1991–1992, 1997 and 2005. Main outcome measures At 8 years, major neurosensory disability (any of moderate/severe cerebral palsy, IQ <−2 SD relative to controls, blindness or deafness), motor, cognitive and academic impairment, executive dysfunction and poor health utility. Risk ratios (RRs) and risk differences between EP22–23 (reference) and other gestational age groups were estimated using generalised linear models, adjusted for era of birth, social risk and multiple birth. Results The risk of major neurosensory disability was higher for EP22–23 (n=21) than more mature groups (168 EP24–25; 312 EP26–27; 576 term), with increasing magnitude of difference as the gestation increased (adjusted RR (95% CI) compared with EP24–25: 1.39 (0.70 to 2.76), p=0.35; EP26–27: 1.85 (0.95 to 3.61), p=0.07; term: 13.9 (5.75 to 33.7), p<0.001). Similar trends were seen with other outcomes. Two-thirds of EP22–23 survivors were free of major neurosensory disability. Conclusions Although children born EP22–23 experienced higher rates of disability and impairment at 8 years than children born more maturely, many were free of major neurosensory disability. These data support providing active care to infants born EP22–23. Data are available upon reasonable request.

中文翻译：

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与更成熟的婴儿相比，妊娠 22-23 周出生的婴儿 8 岁时的神经感觉、认知和学业结果

尽管为更多妊娠<24周出生的婴儿提供重症监护，但对于咨询和决策至关重要的学龄结局数据却很少。目的 比较妊娠 22-23 周（EP22-23）与 24-25 周（EP24-25）、26-27 周（EP26- 27）和期限（≥37周）。设计三个前瞻性纵向队列。背景设定为澳大利亚维多利亚。参与者 所有 EP 活产儿（22-27 周）和 1991-1992 年、1997 年和 2005 年出生的足月出生对照。 主要结果指标 8 岁时，严重神经感觉障碍（任何中度/重度脑瘫，智商 <−2 SD相对于对照组（失明或耳聋）、运动、认知和学业障碍、执行功能障碍和健康效用差。使用广义线性模型估计 EP22-23（参考）和其他孕龄组之间的风险比 (RR) 和风险差异，并根据出生时代、社会风险和多胞胎进行调整。结果 EP22-23 (n=21) 的主要神经感觉障碍的风险高于更成熟的群体 (168 EP24-25; 312 EP26-27; 576 足月)，随着妊娠的增加，差异程度越来越大 (调整后的 RR ( 95% CI) 与 EP24-25 相比：1.39（0.70 至 2.76），p=0.35；EP26-27：1.85（0.95 至 3.61），p=0.07；term：13.9（5.75 至 33.7），p<0.001）。其他结果也出现了类似的趋势。三分之二的 EP22-23 幸存者没有出现严重的神经感觉障碍。结论 尽管 EP22-23 出生的儿童在 8 岁时残疾和损伤的发生率比更成熟出生的儿童更高，但许多人没有出现严重的神经感觉障碍。这些数据支持为 EP22-23 出生的婴儿提供积极护理。数据可根据合理要求提供。