Intervention at the border of viability: perspective over a decade

Area of Science:

• Neonatalogy
• Perinatology
• Maternal-Fetal Medicine

Background:

• Infants born at the border of viability (22-24 weeks gestation) face significant mortality and morbidity.
• Changes in medical technology and practice may influence outcomes for these high-risk neonates.
• Comparing outcomes across different time periods can reveal trends in care and effectiveness.

Purpose of the Study:

• To compare prenatal management and infant outcomes for neonates born between 22 and 24 weeks gestation.
• To evaluate changes in care between two distinct epochs: 1993-1995 (early) and 2001-2003 (late).

Main Methods:

• A cohort study was conducted at a single, high-risk academic perinatal referral center.
• Included were 160 women delivering live infants between 22 0/7 and 24 6/7 weeks gestation.
• Data collected included prenatal management, time to delivery, resuscitation efforts, NICU interventions, and survival morbidities.

Main Results:

• Maternal characteristics were similar between the early and late epochs.
• Women in the late epoch were more likely to receive advanced care, including transport to a higher level of care, sonographic surveillance, antibiotics, and antenatal steroids.
• Infants in the late epoch received more life-sustaining interventions in the NICU, such as high-frequency ventilation, chest tubes, and specific medications for blood pressure support.
• Gestational age-specific mortality rates remained unchanged between the two epochs.

Conclusions:

• Despite increased interventions and advanced care in the later epoch, there was no significant reduction in mortality for infants born at 22 to 24 weeks gestation.
• This suggests that current management strategies may not be sufficient to improve survival rates for extremely premature infants.
• Further research is needed to identify more effective interventions for this vulnerable population.