Survival Among Infants Born at 22 or 23 Weeks' Gestation Following Active Prenatal and Postnatal Care
Katrin Mehler1, André Oberthuer1, Titus Keller1
1Division of Neonatology, Children's Hospital, University of Cologne, Cologne, Germany.
Insights
Active prenatal and postnatal care improved survival rates for extremely premature infants. One in four infants born at the border of viability survived without severe complications, aiding parental decision-making.
Area of Science:
- Neonatal Intensive Care
- Perinatal Medicine
- Pediatric Survival Rates
Background:
- Infant survival rates at the border of viability are low and vary significantly across neonatal intensive care units.
- Optimizing care for extremely premature infants remains a critical challenge in neonatology.
Purpose of the Study:
- To evaluate if active prenatal and postnatal care can enhance survival rates and short-term outcomes for infants born at 22 or 23 weeks' gestation.
- To provide data supporting individualized care decisions for parents of extremely premature infants.
Main Methods:
- Retrospective study of 106 infants born at 22-23 weeks' gestation at a level III neonatal intensive care unit.
- Comparison of outcomes between infants receiving palliative care versus active prenatal and postnatal care.
- Analysis of survival rates and severe neonatal complications, including intraventricular hemorrhage, bronchopulmonary dysplasia, and retinopathy of prematurity.
Main Results:
- Of 86 infants receiving active care, 67% survived to hospital discharge.
- Eighty-five infants (99%) survived without severe short-term complications.
- Survival was positively associated with the Apgar score at 5 minutes and birth weight.
Conclusions:
- Active care strategies can improve survival and reduce severe complications in infants born at the border of viability.
- Findings support individualized parental counseling and decision-making for extremely premature neonates.
- Further research on long-term childhood outcomes following active care is warranted.
Importance:
Rates of survival for infants born at the border of viability are still low and vary considerably among neonatal intensive care units.
Objective:
To determine whether higher survival rates and better short-term outcomes for infants born at 22 or 23 weeks' gestation may be achieved by active prenatal and postnatal care.
Design, Setting, And Participants:
Retrospective study of 106 infants born at 22 or 23 weeks of gestation at a level III neonatal intensive care unit at the University of Cologne Medical Centre in Cologne, Germany, between January 1, 2010, and December 31, 2014. Data analysis was performed in June 2015.
Exposures:
Active prenatal and postnatal care.
Main Outcomes And Measures:
Survival until hospital discharge and survival without neonatal or short-term severe complications (defined as high-grade intraventricular hemorrhage, surgery for abdominal complications, bronchopulmonary dysplasia, or retinopathy of prematurity).
Results:
Of 106 liveborn infants (45 born at 22 weeks and 61 born at 23 weeks and 6 days), 20 (19%) received palliative care (17 born at 22 weeks and 3 born at 23 weeks), and 86 (81%) received active care (28 born at 22 weeks and 58 born at 23 weeks). Of the 86 infants who received active care (mean [SD] maternal age, 32 [6] years), 58 (67%) survived until hospital discharge (17 born at 22 weeks and 41 born at 23 weeks). Eighty-five infants survived without severe complications, with 1 infant born at 22 weeks excluded because of missing data (6 of 27 [22%] born at 22 weeks, and 16 of 58 [28%] born at 23 weeks). Survival was predicted by the Apgar score after 5 minutes (odds ratio, 0.62 [95% CI, 0.46-0.84]) and birth weight (odds ratio, 0.001 [95% CI, 0.00-0.40]).
Conclusions And Relevance:
One in 4 infants born at the border of viability and offered active care survived without severe complications. This finding should be considered for individualized parental approaches and decision making. Active follow-up information is required to determine childhood outcomes.
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