Early adult outcomes following delivery at 23–26 weeks of gestation

Abstract

Objective. There are few reports of young adult outcomes of infants born at 23–26 weeks gestation. The objective of this study is to report educational, health, social, and employment outcomes of a large cohort of these infants born during an era when significant advances in neonatal care led to a marked increase in survival. Methods. Medical records of 316 infants who were born between January 1, 1986 and December 31, 1990, were analyzed retrospectively. Two hundred three (64%) infants survived to discharge home, and 5 died following discharge, leaving 198 young adults available for follow-up. One hundred sixty-two (82%) young adults responded to a 27 item telephone questionnaire designed to assess educational, health, social, and employment status at a mean age of 19.3 years. Parents of subjects were interviewed in cases where subjects could not be contacted or had cognitive issues which precluded their responding (19 subjects). Parent social and educational status was previously obtained by response to a phone survey at eight year follow-up and also by phone interview of parents of young adults previously not available for follow-up, but who were located for this report. Results. The only statistically significant differences between the 162 young adult responders and the 36 non-responders were a younger maternal age at delivery (28 ± 6 years vs 25 ± 6 years, respectively, p = 0.015) and race (91% of responders were white compared to 67% of the non-responders, p = 0.001). One hundred forty-three (88%) young adults had graduated from high school. Eighty-four (52%) required educational assistance in the form of special education, a tutor, or an Individual Education Plan (IEP). Ninety-one (56%) were currently enrolled in post-secondary education. These levels of educational achievement closely correspond to the 91% of their mothers who graduated from high school and the 57% who had completed some college level courses, including 30% with either four-year or advanced degrees. Twenty-nine (18%) of the young adults interviewed reported some problems with depression. Thirty subjects admitted to using alcohol socially, 11 reported tobacco use, and 3 admitted to using marijuana. One hundred forty-two have been or are currently employed. Conclusions. The majority of infants born at the lower limits of viability not only have the potential to survive, but with appropriate assistance and resources have the ability to successfully navigate the educational system and eventually be employed as productive members of society.