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Survival prospects of extremely preterm infants: a 10-year experience in a single perinatal center
1Department of Paediatrics, Monash University, Monash Medical Centre, Clayton, Victoria, Australia.
Insights
Survival rates for premature infants born between 23 and 28 weeks gestation improved with gestational age. Active perinatal management significantly improved outcomes for these high-risk newborns.
Area of Science:
- Perinatology
- Neonatology
- Public Health
Background:
- Premature birth presents significant challenges to infant survival.
- Understanding survival rates by gestational age is crucial for clinical decision-making.
Purpose of the Study:
- To analyze survival rates of inborn infants born between 23 and 28 weeks gestation over a 10-year period.
- To identify factors influencing survival, including gestational age, multiple gestations, and management strategies.
Main Methods:
- Retrospective analysis of 442 inborn live births between 23 and 28 weeks gestation from 1977 to 1986.
- Comparison of survival rates based on gestational age, singleton vs. multiple births, and obstetric/neonatal interventions.
Main Results:
- Overall survival rate was 53%, with significant increases in survival correlating with advancing gestational age (7% at 23 weeks to 71% at 28 weeks).
- Singleton births had higher survival (58%) than multiple births (41%). Cesarean section rates increased, while neonatal intensive care rates remained stable.
- 10% of infants received no treatment due to major malformations or perceived nonviability.
Conclusions:
- Gestational age is a primary determinant of survival for extremely premature infants.
- Active perinatal management strategies positively impact survival rates.
- Data on gestational age-specific survival is essential for guiding obstetric and neonatal care decisions.
Abstract:
During a 10-year period, 1977 to 1986, 233 (53%) of 442 inborn live births between 23 and 28 weeks' gestation survived; their 1-year survival rate was 7% at 23 weeks, 30% at 24 weeks, 31% at 25 weeks, 55% at 26 weeks, 67% at 27 weeks, and 71% at 28 weeks. No significant change in survival rate was observed over the years. Twelve percent of pregnancies and 20% of infants were multiple gestations. Singleton births had significantly higher survival rates compared with multiple births (58% versus 41%). The obstetric intervention rate, as measured by the frequency of cesarean section, increased significantly over the years: from 15% in 1977-1978 to 33% in 1985-1986. The neonatal intervention rate, as measured by the frequency of live births offered neonatal intensive care, remained unchanged. Ten percent were not treated: 4% had major malformations and 6% were considered "nonviable." Active perinatal management, which assumed fetal-neonatal viability, accounted for better survival rates compared with centers with a more passive management policy. Information on survival based on gestational cohorts plays an important role in helping obstetricians, neonatologists, and parents make appropriate management decisions.