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"Early" versus "late" 23-week infant outcomes
Thinh P Nguyen1, Erol Amon, Mohamad Al-Hosni
1Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health, Saint Louis University School of Medicine, St. Louis, MO, USA.
Insights
Infants born between 23 weeks and 4 days gestation ("late") had significantly better survival rates (56%) than those born earlier (25%). A delay of just 24-96 hours in delivery may improve outcomes for extremely premature infants.
Area of Science:
- Neonatalogy
- Perinatology
- Obstetrics
Background:
- Extremely premature infants born at 23 weeks gestation face significant survival challenges.
- The precise gestational age within the 23-week range may influence neonatal outcomes.
Purpose of the Study:
- To compare survival rates between infants born in the early part of 23 weeks gestation (23 0/7–23 3/7 weeks) and the late part (23 4/7–23 6/7 weeks).
Main Methods:
- Retrospective analysis of 126 liveborn infants delivered between 23 0/7 and 23 6/7 weeks gestation (2001-2010).
- Data sourced from the Vermont Oxford Network database.
- Clinical characteristics and survival were compared between "early" and "late" gestational age groups using multivariate analyses.
Main Results:
- Survival rates were 25% for early 23-week infants and 56% for late 23-week infants (P < .001).
- The early group received fewer antenatal steroids (43% vs 65%) and had lower mean birthweight (547g vs 596g).
- No significant changes in survival were observed over the study period for either group.
Conclusions:
- Infants born in the later part of 23 weeks gestation demonstrate significantly improved survival.
- Even a short delay in delivery (24-96 hours) may enhance survival for infants born at 23 weeks gestation.
Objective:
To determine whether survival is different in "early" (23(0/7)-23(3/7) weeks) vs "late" (23(4/7)-23(6/7) weeks) infants.
Study Design:
Records of 126 consecutive liveborn infants delivered at 23(0/7) to 23(6/7) weeks' gestation from 2001-2010 were examined using the Vermont Oxford Network database. Infants born at 23 0/7 to 23 3/7 weeks were grouped into "early" and those at 23 4/7 to 23 6/7 weeks were "late." Clinical characteristics were compared between groups and multivariate analyses were used to predict survival.
Results:
Seventy-two infants were early and 54 were late. Survival was 25% vs 56%, respectively (P < .001). The early group was less likely to receive steroids (43% vs 65%; P = .016) and had a lower mean birthweight (547 g vs 596 g; P < .001). No difference in other factors was seen between groups. No change in survival was observed during the study period in either group.
Conclusion:
Late 23-week infants have improved survival compared with early infants. Delaying delivery as little as 24-96 hours may improve survival for 23-week infants.
