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[Morbidity and mortality in newborns at the limit of viability in Spain: a population-based study]
F García-Muñoz Rodrigo1, A García-Alix Pérez2, J A García Hernández3
1Servicio de Neonatología, Complejo Hospitalario Universitario Insular Materno-Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
Insights
Survival rates for extremely premature infants (gestational age ≤ 26 weeks) in Spain are low, especially for those born before 23 weeks. Infants born at 25 weeks or later have better survival and morbidity outcomes, warranting intensive care.
Area of Science:
- Neonatology
- Perinatal Medicine
- Public Health
Context:
- Perinatal care for extremely premature newborns (gestational age ≤ 26 weeks) presents significant clinical and ethical challenges.
- High-quality survival data is crucial for informed decision-making by healthcare professionals and families.
- This study addresses the need for specific survival and morbidity rates in this vulnerable population within Spain.
Purpose:
- To determine gestational age-specific survival rates at hospital discharge for newborns ≤ 26 weeks gestation.
- To assess survival rates without major morbidities in extremely premature infants.
- To provide evidence-based data for guiding resuscitation and intensive care decisions in Spain.
Summary:
- A total of 3,236 infants ≤ 26 weeks gestation were analyzed from the SEN1500 network (2004-2010).
- Survival rates at 22, 23, 24, 25, and 26 weeks gestation were 12.5%, 13.1%, 36.9%, 55.7%, and 71.9%, respectively.
- Survival without major morbidity (e.g., severe intracranial hemorrhage, bronchopulmonary dysplasia) was 1.5% at 23 weeks, increasing to 29.9% at 26 weeks.
Impact:
- Survival without major morbidity is exceptional before 23 weeks gestation and scarce at 23-24 weeks.
- Infants ≥ 25 weeks gestation have reasonable survival chances and should be considered for active resuscitation and intensive care.
- Continuous monitoring and comparison of center-specific results with population-based data are vital for improving care.
Introduction:
Perinatal care in extremely immature newborns is a clinical and ethical problem of great importance for professionals and families, and requires that the available information on the chances of child survival is of the highest quality. The aim of this study was to determine the specific rates of survival at hospital discharge, and survival without major morbidity in newborns with a gestation age (GA) ≤ 26 weeks in Spain.
Patients And Methods:
We included live newborns ≤ 26 weeks admitted to the collaborating centers of the SEN1500 network (2004-2010). Out born patients, infants who died in delivery room, and those with congenital anomalies incompatible with life were excluded.
Results:
A total of 3,236 patients were included. GA specific survival was 12.5, 13.1, 36.9, 55.7, and 71.9% at 22, 23, 24, 25, and 26 weeks of GA, respectively. Survival without severe intracranial hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, and/or retinopathy of prematurity was 1.5, 9.5, 19.0, and 29.9% at 23, 24, 25 and 26 weeks GA, respectively.
Conclusions:
Survival without major morbidity in infants less than 23 weeks GA is exceptional, and scarce in newborns with 23 and 24 weeks GA. Infants ≥ 25 weeks GA have reasonable chances of survival and, in the absence of major malformations or other relevant complications, should be offered active resuscitation and intensive care. The continuous updating of the results of individual centers is of utmost importance, as well as their comparison with the reference population-based results.
