Related Experiment Video
Updated: Aug 6, 2026
Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
Published on: November 20, 2015
Preterm birth at 23 to 26 weeks' gestation: is active obstetric management justified?
C G Nwaesei1, D C Young, J M Byrne
1Department of Neonatal Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Active perinatal management for preterm births at 23-26 weeks
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.
Abstract:
To determine if active perinatal management was justified in preterm deliveries at less than or equal to 26 weeks' gestation, the outcome (survival and short- and long-term morbidity) of 43 infants (group I) born between 23 and 26 weeks' gestation was compared with that of 17 infants (group II) born at 27 weeks' gestation. Of the 12 surviving infants in group I (survival 28%), 11 were ventilated (median = 50 days), eight had moderate to severe bronchopulmonary dysplasia, and four had mild retrolental fibroplasia. At follow-up, two infants had physical disabilities with moderate to severe functional impairment, one had a minor disability, and nine had normal neurodevelopment. In contrast, of the 13 surviving infants in group II (survival 76%), nine were ventilated (median = 8 days), six had moderate to severe bronchopulmonary dysplasia, and six had mild RLF. At follow-up, one infant had a physical disability with moderate to severe functional impairment, four had minor disabilities, and eight had normal development. Perinatal factors that positively influenced survival in the two groups combined included active perinatal management, antenatal steroids, female sex, and absence of clinical chorioamnionitis and asphyxia. Although group I infants had a significantly higher mortality rate (p less than 0.05) and required a longer duration of ventilation (p less than 0.05), no differences in the incidence of postnatal complications or long-term morbidity at 2 to 4 years of age were evident between the two groups.
Related Concept Videos
01:22Diabetes Mellitus: Type 2 and Gestational
01:19Mitral Valve Prolapse III: Nursing Management