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Prognosis for infants born at 23 to 28 weeks' gestation
Insights
Survival rates for extremely preterm infants improve significantly with gestational age. Early predictions aid in guiding intensive care decisions for these vulnerable newborns.
Area of Science:
- Neonatology
- Perinatal Medicine
- Developmental Pediatrics
Background:
- Extremely preterm infants (23-28 weeks gestation) face significant survival and neurodevelopmental challenges.
- Outcomes for this population are highly dependent on gestational age at birth.
- Previous data may not fully reflect current intensive care capabilities for non-viable infants.
Purpose of the Study:
- To report survival and neurodevelopmental outcomes for 356 extremely preterm infants.
- To analyze outcomes by week of gestation, sex, and birth multiplicity.
- To inform guidelines for perinatal intensive care and parental prognostication.
Main Methods:
- Retrospective analysis of 356 infants born between 23 and 28 weeks' gestation.
- Assessment of corrected 1-year survival and neurodevelopmental impairment (NDI).
- Evaluation of outcome prediction models at different time points (pre-delivery, post-resuscitation, 1 week).
Main Results:
- Corrected 1-year survival increased from 7% at 23 weeks to 75% at 28 weeks.
- Overall incidence of impairment was 19%, with major disability at 12%.
- Male infants and those from multiple births had lower survival and higher impairment rates.
Conclusions:
- Gestational age is a critical determinant of survival and neurodevelopmental outcome in extremely preterm infants.
- Outcome prediction models can assist in decision-making regarding intensive care and parental counseling.
- Careful monitoring of intensive care for increasingly immature infants is essential.
Abstract:
The survival and neurodevelopmental outcome of 356 extremely preterm infants born at 23 to 28 weeks' gestation were reported by week of gestation. Their corrected 1 year survival improved from 7% at 23 weeks to 75% at 28 weeks. The overall incidence of impairment was 19% and of major disability 12%. Boys had a significantly lower normal survival than girls. Multiple births had a significantly lower survival and higher incidence of impairment than singleton births. Predictions of outcome were made before delivery, after resuscitation, and at 1 week to aid the development of guidelines on when perinatal intensive care is justified, whether obstetric intervention for fetal reasons is warranted, and what initial and ongoing prognoses to give to parents. Intensive care for progressively smaller and more immature infants, many of whom were previously considered non-viable, needs to be carefully monitored by every perinatal centre.