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Published on: November 20, 2015
Increased Survival Concomitant with Unchanged Morbidity and Cognitive Disability among Infants Born at the Limit of
Yasemin Christiansson1, Maria Moberg1, Alexander Rakow1,2
1Karolinska University Hospital, Karolinska Institutet, Akademiska Stråket 14, 171 64 Stockholm, Sweden.
Insights
New guidelines improved survival for extremely preterm infants born before 24 weeks gestation. While neonatal mortality decreased, long-term morbidity and cognitive outcomes remained unchanged, highlighting ethical considerations for intervention.
Area of Science:
- Perinatal Medicine
- Neonatology
- Maternal-Fetal Medicine
Background:
- Investigating risk factors and outcomes for infants born at the limit of viability.
- Evaluating the impact of extended interventionist guidelines on extremely preterm births.
Purpose of the Study:
- To determine maternal risk factors for extreme preterm birth.
- To assess infant outcomes, including mortality, morbidity, and cognitive function, before and after new intervention guidelines.
Main Methods:
- Retrospective cohort study of births between 22 and 23 weeks gestational age.
- Comparison of outcomes between 2009-2015 (pre-guidelines) and 2016-2019 (post-guidelines).
- Monitoring of infant mortality, morbidity, and cognitive function at 2 years corrected age.
Main Results:
- Neonatal mortality decreased significantly for infants born at 22 and 23 weeks gestation post-guidelines.
- Two-year survival rates increased significantly for infants born at 23 weeks gestation.
- Somatic morbidity and cognitive disability at 2 years corrected age remained unchanged.
Conclusions:
- Maternal risk factors for extreme preterm birth necessitate standardized follow-up and counseling.
- Increased infant survival with unchanged morbidity underscores the importance of ethical considerations in interventionist approaches.
- The findings support a nuanced approach to managing pregnancies at the limit of viability.
Introduction:
The aim was to determine risk factors among mothers and outcomes for their children born at the limit of viability in 2009-2019, before and after the introduction of extended interventionist guidelines.
Methods:
A retrospective cohort study of births at 22 + 0-23 + 6 gestational weeks in a Swedish Region in 2009-2015 (n = 119), as compared to 2016-2019 (n = 86) after the introduction of new national interventionist guidelines. Infant mortality, morbidity, and cognitive functions at 2 years corrected age according to the Bayley-III Screening Test were monitored.
Results:
Maternal risk factors for extreme preterm birth were identified. The intrauterine fetal death rates were comparable. Among births at 22 weeks, the neonatal mortality tended to decrease (96 vs. 76% of live births (p = 0.05)), and the 2-year survival tended to increase (4 vs. 24% (p = 0.05)). Among births at 23 weeks, the neonatal mortality decreased (56 vs. 27% of live births (p = 0.01)), and the 2-year survival increased (42 vs. 64% (p = 0.03)). Somatic morbidity and cognitive disability at 2 years corrected age were unchanged.
Conclusion:
We identified maternal risk factors that emphasize the need for standardized follow-up and counseling for women at increased risk of preterm birth at the limit of viability. The increased infant survival concomitant with unchanged morbidity and cognitive disability highlight the importance of ethical considerations regarding interventionist approaches at threatening preterm birth before 24 weeks.
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