{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T20:00:17Z","timestamp":1782331217602,"version":"3.54.5"},"reference-count":20,"publisher":"BMJ","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Dis Child Fetal Neonatal Ed"],"published-print":{"date-parts":[[1998,3,1]]},"abstract":"<jats:sec>\n                  <jats:title>AIMS<\/jats:title>\n                  <jats:p>To assess whether changes in survival over time in infants of 23 to 25 weeks of gestational age were accompanied by changes in the incidence of disability in childhood during an 11 year period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec sec-type=\"methods\">\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Obstetric and neonatal variables having the strongest association with both survival to discharge from a regional neonatal medical unit and neurodevelopmental disability in 192 infants of 23 to 25 weeks of gestation, born in 1984 to 1994, were studied as a group and in two cohorts (1984 to 1989 n = 96 and 1990 to 1994 n = 96). The data collected included CRIB (clinical risk index for babies) scores and cranial ultrasound scan findings. The children were followed up at outpatient clinics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Between 1984 and 1989 (cohort 1) and 1990 and 1994 (cohort 2) the rate of survival to discharge increased significantly from 27% to 42% and the rate of disability in survivors increased from 38% to 68% ; most of this increase was in mild disability. The proportions of survivors with cerebral palsy did not alter significantly (21% <jats:italic>vs<\/jats:italic> 18%), but more survivors with blindness due to retinopathy of prematurity (4% <jats:italic>vs<\/jats:italic>18%), myopia (4% <jats:italic>vs<\/jats:italic> 15%) and squints (8%<jats:italic>vs<\/jats:italic> 13%) contributed to the increased rate of disability. Clinically significant cranial ultrasound findings and a high CRIB score were strongly associated with death. A high CRIB score was most strongly associated with disability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>The rise in disability with improved survival was not due to cerebral palsy; rather the main contributors were blindness due to retinopathy, myopia, and squint. The causes of these disabilities seem to be linked to high CRIB scores. A system of regular and skilled retinal examination and access to facilities for retinal ablation should be in place in all neonatal units which undertake the care of such extremely preterm infants.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/fn.78.2.f99","type":"journal-article","created":{"date-parts":[[2009,4,8]],"date-time":"2009-04-08T11:39:16Z","timestamp":1239190756000},"page":"F99-F104","source":"Crossref","is-referenced-by-count":130,"title":["Increased survival and deteriorating developmental outcome in 23 to 25 week old gestation infants, 1990\u20134 compared with 1984\u20139"],"prefix":"10.1136","volume":"78","author":[{"given":"H C A","family":"Emsley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S P","family":"Wardle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D G","family":"Sims","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M L","family":"Chiswick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S W","family":"D\u2019Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1998,3,1]]},"reference":[{"key":"2025090513054132000_78.2.F99.1","doi-asserted-by":"crossref","first-page":"F214","DOI":"10.1136\/fn.74.3.F214","article-title":"Perinatal management at the lower margin of viability.","volume":"74","author":"Rennie","year":"1996","journal-title":"Arch Dis Child"},{"key":"2025090513054132000_78.2.F99.2","doi-asserted-by":"crossref","unstructured":"Yu VYH Carse EA Charlton MP (1996) Outcome of infants born at less than 26 weeks gestation . in Current Topics in Neonatology Number 1. eds Hansen TN McIntosh N (W B Saunders, London), pp 67\u00e2\u0080\u009384.","DOI":"10.1016\/S1084-2756(96)80045-5"},{"key":"2025090513054132000_78.2.F99.3","doi-asserted-by":"crossref","first-page":"1642","DOI":"10.1056\/NEJM198912143212405","article-title":"Outcomes of extremely low birthweight infants between 1982 and 1989.","volume":"321","author":"Hack","year":"1989","journal-title":"N Engl J Med"},{"key":"2025090513054132000_78.2.F99.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199311253292201"},{"key":"2025090513054132000_78.2.F99.5","doi-asserted-by":"publisher","DOI":"10.1136\/adc.64.5.678"},{"key":"2025090513054132000_78.2.F99.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.306.6894.1715"},{"key":"2025090513054132000_78.2.F99.7","first-page":"1","article-title":"Extreme prematurity: outcome of 568 pregnancies of 23-26 weeks gestation.","volume":"82","author":"Whyte","year":"1993","journal-title":"Obstet Gynaecol"},{"key":"2025090513054132000_78.2.F99.8","doi-asserted-by":"crossref","first-page":"F28","DOI":"10.1136\/fn.71.1.F28","article-title":"Factors affecting survival and outcome at 3 years in extremely preterm infants.","volume":"71","author":"Cooke","year":"1994","journal-title":"Arch Dis Child"},{"key":"2025090513054132000_78.2.F99.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)82015-3"},{"key":"2025090513054132000_78.2.F99.10","first-page":"479","article-title":"Outcome of infants weighing less than 800 grams at birth: 15 years experience.","volume":"96","author":"La Pine","year":"1995","journal-title":"Pediatrics"},{"key":"2025090513054132000_78.2.F99.11","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(93)92296-6"},{"key":"2025090513054132000_78.2.F99.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(95)90758-0"},{"key":"2025090513054132000_78.2.F99.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(95)70003-X"},{"key":"2025090513054132000_78.2.F99.14","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/S0022-3476(95)70008-0","article-title":"One year follow up of 89 infants with birthweights of 500-749 grams and respiratory distress syndrome randomized to two rescue doses of synthetic surfactant or air placebo.","volume":"126","author":"Casiro","year":"1995","journal-title":"J Pediatr"},{"key":"2025090513054132000_78.2.F99.15","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/S0022-3476(95)70012-9","article-title":"Double blind, randomized placebo-controlled Canadian multicentre trial of two doses of synthetic surfactant or air placebo in 224 infants weighing 500 to 749 grams with respiratory distress syndrome.","volume":"126","author":"Smyth","year":"1995","journal-title":"J Pediatr"},{"key":"2025090513054132000_78.2.F99.16","unstructured":"Griffiths R (1954) Abilities of Babies: A Study in Mental Measurement. 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