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Published on: November 20, 2015
Morbidity and mortality of preterm infants less than 26 weeks of gestational age
Maria I da Cunha Durães1, Filipa Flor-De-Lima2,3, Gustavo Rocha3
1Department of Pediatrics, Faculty of Medicine, Porto University, Porto, Portugal - mimed10158@med.up.pt.
Insights
Extreme preterm infants born between 23 and 25 weeks gestation face high mortality and significant morbidities. Encouraging antenatal steroid use may improve outcomes for these vulnerable neonates.
Area of Science:
- Neonatology
- Perinatal Medicine
- Neonatal Intensive Care
Background:
- Extreme preterm infants (23+0 to 25+6 weeks gestation) face high risks of mortality and morbidity.
- This gestational age range is considered a "gray zone" with uncertain prognoses, complicating medical decision-making.
- Evaluating neonatal outcomes in this vulnerable population is crucial.
Purpose of the Study:
- To assess the neonatal morbidity and mortality rates of preterm infants born between 23+0 and 25+6 weeks gestation.
- To identify factors associated with mortality in this extreme preterm group.
- To inform clinical practice and future research for improving outcomes.
Main Methods:
- Retrospective study of inborn preterm infants (23+0–25+6 weeks gestation).
- Infants were admitted to a level IIIC Neonatal Intensive Care Unit (NICU) between 1996 and 2014.
- Data on neonatal morbidity and mortality were collected and analyzed.
Main Results:
- 72 preterm neonates were included; 75% died.
- Major morbidities included respiratory distress syndrome (RDS), patent ductus arteriosus, and sepsis.
- Discharge morbidity was high, with severe bronchopulmonary dysplasia and retinopathy of prematurity being frequent.
Conclusions:
- The survival rate was 25%, with substantial morbidity at discharge.
- Hypotension was the only factor associated with increased mortality.
- Antenatal steroid use in extremely preterm infants should be encouraged to improve outcomes.
Background:
Extreme preterm infants have a high risk of morbidity and mortality. Newborns delivered between 23+0 and 25+6 weeks, are considered to be in the "gray zone" and have uncertain prognosis. For these children medical decision-making becomes complex and controversial. The present study intends to evaluate the neonatal morbidity and mortality of preterm infants born between 23 weeks and 25+6 weeks of gestational age.
Methods:
A retrospective study was conducted including all inborn preterm infants, with a gestational age between 23+0 and 25+6 weeks, admitted to a level IIIC NICU, between January 1st, 1996 and December 31st, 2014.
Results:
A total of 72 preterm neonates were included, 18.1% had a full cycle of antenatal steroids. The most frequent major morbidities were RDS (95.4%), patent ductus arteriosus (81.3%), sepsis (55.7%, being 19.7% early sepsis, and 36.1% late sepsis), intraventricular hemorrhage (34.4%), retinopathy of prematurity (21.9%) and necrotizing enterocolitis (10.9%). Fifty-four (75%) children died. The only factor adjusted to age associated with high mortality founded was hypotension (OR=4.99, P<0.019). Morbidity at discharge was: severe bronchopulmonary dysplasia (77.8%), retinopathy of prematurity (72.2%), intraventricular hemorrhage (16.7%), cystic periventricular leukomalacia (11.1%), and sequalae of necrotizing enterocolitis (5.6%).
Conclusions:
The survival rate was 25% and a high morbidity at discharge was observed, which leave us with the huge responsibility to improve this result in a near future. Extreme prematurity is still a very controversial and complex issue and particular challenge for neonatologists. The use of antenatal steroid in the more immature preterm infants should be encouraged.
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