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ObjectiveSurvival rates of extremely premature infants are rising, but changes in neurodevelopmental impairment (NDI) rates are unclear. Our objective was to perform a systematic review of intrainstitutional variability of NDI over time.DesignSystematic review and meta-analysis.Data sourcesOvid MEDLINE, Embase, PubMed, Cochrane Library and Google Scholar.Study selectionStudy eligibility: (1) at least two discrete cohorts of infants born Main outcomeChange in NDI rates. Quality, validity and bias were assessed using Grading of Recommendations, Assessment, Development, and Evaluation and Quality in Prognosis Studies guidelines.ResultsOf 203 publications, 15 were eligible, including 13 229 infants. At the first time point, average NDI rate across study groups weighted by sample size was 41.0% (95% CI 34.0% to 48.0%). The average change in NDI between time points was −3.3% (95% CI −8·8% to 2.2%). For each added week of gestation at birth, the rate of NDI declined by 9.7% (95% CI 6.2% to 13.3%). Most studies exhibited moderate–severe bias in at least one domain, especially attrition rates.ConclusionsWhen comparing discrete same-centre cohorts over time, there was no significant change in NDI rates in infants born |
