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Centre for
Reproduction, Growth and Development, University of Leeds, D
Floor Clarendon Wing, The General Infirmary at Leeds, Leeds LS2
9NS, UK
Correspondence to: Dr Evans, Neonatal Intensive Care Unit, Southmead Hospital, Bristol BS10 5NB, UK evans_d{at}southmead.swest.nhs.uk
Accepted 26 October
2000
OBJECTIVE
To determine
by how much selection bias in preterm infant cohort studies results in
an overestimate of survival.
DESIGNSystematic
review of studies reporting survival in infants less than 28 weeks of
gestation published 1978-1998. Studies were graded according to cohort
definition: A, stillbirths and live births; B, live births; C, neonatal
unit admissions. Proportions of infants surviving to discharge were
calculated for each week of gestation.
RESULTSSixty seven
studies report data on 55 cohorts (16 grade A, 23 grade B, 16 grade C).
Studies that are more selective report significantly higher survival
between 23 and 26 weeks of gestation (grade C > grade B > grade
A, p < 0.01), exaggerating survival by 100% and 56% at 23 and 24 weeks respectively.
CONCLUSIONTo minimise
the potential for overestimating survival around the limits of
viability, future studies should endeavour to report the outcome of all
pregnancies for each week of gestation (terminations, miscarriages,
stillbirths, and all live births).
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