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Care for infants born at 23 weeks gestational age: 5 years' experience from a large medical center
Michael S Schimmel1, Avraham Steinberg2, Francis B Mimouni1
1a Department of Neonatology .
Insights
Parental decisions for extremely premature infants at 23 weeks gestation significantly impact survival. Demographic factors do not predict these choices, highlighting the need for counseling focused on outcomes.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Bioethics
Background:
- Infants born at 23 weeks gestation represent the earliest viable gestations.
- Parental decision-making profoundly influences the management and outcomes of these extremely preterm infants.
- Understanding factors guiding parental choice is crucial for ethical and effective neonatal care.
Purpose of the Study:
- To assess parental decision-making regarding the care of infants born at 23 weeks gestation.
- To identify factors influencing parental choices between comfort care and full medical intervention.
- To evaluate the impact of parental decisions on infant survival rates.
Main Methods:
- Retrospective review of neonatal records for infants born at 23 weeks gestation between 2010 and 2014.
- Analysis of demographic and clinical variables associated with parental decisions.
- Comparison of survival rates based on chosen care pathways.
Main Results:
- Of 33 infants born at 23 weeks, 17 received comfort care only (no survivors), while 16 received full medical care (3 survivors).
- Demographic factors including birth year, gender, multiple gestation, assisted reproductive technology use, religious background, and physician specialization did not significantly predict parental decisions.
- Parental choice was a significant determinant of infant outcome.
Conclusions:
- Parental decisions for extremely preterm infants at 23 weeks gestation are complex and not reliably predicted by demographic data.
- Counseling for these high-stakes decisions should prioritize discussion of local institutional experience and expected outcomes.
- Focusing on evidence-based outcomes can better support families in making informed choices for their infants.
Objectives:
Assessing parental choice regarding care of infants born at 23 weeks' gestation.
Methods:
Neonatal records review.
Results:
During 2010-2014, of 26 births (33 infants), 13 families (17 newborns) conceded comfort care only with no survivors, while 13 families (16 babies) requested full medical care and three survived. With birth year, gender, multi-fetal pregnancy, assisted reproductive technology, religious background and specialization of physician counseling at delivery as independent variables, none significantly affected parental decision; yet, that decision impacted outcome.
Conclusions:
Parental choice regarding infants born at 23 weeks' gestation cannot be predicted from demographics; counseling should concentrate on local experience/outcome.
