Preterm birth at 23 to 26 weeks' gestation: is active obstetric management justified?

Area of Science:

• Neonatalogy
• Perinatology
• Pediatric Outcomes

Background:

• Preterm birth at less than or equal to 26 weeks' gestation presents significant survival and morbidity challenges.
• Optimal perinatal management strategies for extremely preterm infants remain a critical area of research.

Purpose of the Study:

• To evaluate the justification of active perinatal management in deliveries at less than or equal to 26 weeks' gestation.
• To compare the outcomes, including survival and morbidity, of infants born at 23-26 weeks with those born at 27 weeks.

Main Methods:

• Retrospective comparison of two groups of infants: Group I (23-26 weeks' gestation, n=43) and Group II (27 weeks' gestation, n=17).
• Outcomes assessed included survival rates, need for ventilation, bronchopulmonary dysplasia, retrolental fibroplasia, and neurodevelopmental status at 2-4 years.
• Perinatal factors influencing survival were analyzed.

Main Results:

• Group I had a significantly lower survival rate (28%) compared to Group II (76%) (p<0.05).
• Group I infants required longer ventilation (median 50 days vs. 8 days) and had high rates of bronchopulmonary dysplasia and retrolental fibroplasia.
• Despite higher mortality and longer ventilation in Group I, no significant differences in postnatal complications or long-term morbidity (2-4 years) were observed between the groups.

Conclusions:

• Active perinatal management is associated with improved survival for extremely preterm infants.
• While short-term outcomes like ventilation duration and complications are higher in the extremely preterm group, long-term neurodevelopmental and physical outcomes at 2-4 years do not significantly differ from those born at 27 weeks.
• Factors such as active perinatal management, antenatal steroids, and absence of asphyxia positively influenced survival.