On the limit of viability extremely low gestational age at birth

Survival is not an adequate measure of success when managing preterm infants < 24 weeks gestational age (GA).

To evaluate neonatal morbidity, survival rate and outcome of preterm infants < 24 weeks GA at birth, in our Neonatal Intensive Care Unit.

Retrospective chart review, 1996-2009. Collected data included neonatal morbidity and mortality, follow-up at the outpatient department regarding to medical problems and neurodevelopmental and behavioural outcomes.

53 preterm neonates (27 male/ 26 female) were included; weight at birth: 630 g (360-870); gestational age: 23.5 wks (22-24); outborn: 9 (17%); any antenatal steroid: 57%. Neonatal morbidity included: hypotension 68%; respiratory distress syndrome: 98%; pneumothorax: 11%; patent ductus arteriosus: 42%; noso sepsis: 72%; necrotizing enterocolitis (>2A): 54%; intraventricular hemorrhage (III+IV): 34%; retinopathy of prematurity (>2): 20%; bronchopulmonary dysplasia: 71%. Mortality rate was 87% (n = 46). Antenatal steroids rate was 71% and 54%, for survivors and deceased newborns, respectively. Out of the seven (13% of total) survivors aged between 7 months and 14 years old (two under 24 months), five (71%) present major sequelae at the follow-up, while two (29%) exhibit normal “border line” development.

Based on these findings it seems that other characteristics of the infants and pregnancies, and not gestational age alone, should be considered before a decision is taken.