Our purpose was to examine the neurodevelopmental outcome at 18 months corrected age of surviving ELGA infants of 23-25 weeks gestation born in 1991-3, and to compare the results with those from an earlier cohort born in 1983-9 (Synnes A et al J Pediatr 1994:125:952-60). ELGA infants delivered in British Columbia's tertiary perinatal center had their gestational age (GA) ascertained as accurately as possible by early ultrasound and dates using predetermined criteria. There were no survivors at <23 weeks in the two time periods. The results of multidisciplinary assessments performed at a corrected age of 18 months were reviewed for survivors of 23-25 weeks GA. Major impairment was defined as a Bayley MDI below -2 s.d., definite signs of cerebral palsy (CP), visual acuity in the better eye with optimal refractive correction worse than 20/200, or sensorineural hearing loss requiring amplification. Of 111 live births, 48 survived to 18 months corrected age and follow-up data was available in 35 (73%). 4 of 12 infants with major impairment, had multiple impairments. The recent cohort was smaller in size(3-year vs 7-year period) and the follow-up rate was lower (73% vs 93%), with a sampling bias toward the lower birthweight infants. Survival rate (to discharge) for 23-25 weeks GA has not improved (44% vs 44%) and the survivors had comparable incidence of major impairment at 18 months (34%; vs 36% resp.). Of children with impairments, multiple impairments were present in 33% (vs 38% in earlier cohort). As there were so few 23 week babies, the results were re-analyzed for infants 24-25 weeks GA. Survival (53% vs 50%) and impairment rate (32% vs 34%) remained not statistically different. There is no evidence in this survey that the introduction of recent innovations such as surfactant therapy has produced any improvement in outcomes for the smallest babies.Table

Table 1
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