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Enhanced Survival of 22-25 Week Preterm Infants After Proactive Care Implementation: A Comparative Analysis of Two

Sae Yun Kim1, Jeongmin Shin1, Moon Yeon Oh1

  • 1Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.

Indian Journal of Pediatrics
|June 5, 2024
PubMed

Insights

Proactive perinatal care significantly improved survival rates for periviable preterm infants. This minimal handling approach reduced mortality and combined morbidities, enhancing clinical outcomes for vulnerable newborns.

Area of Science:

  • Neonatalogy
  • Perinatal Medicine
  • Pediatric Critical Care

Background:

  • Periviable preterm infants (22-25 weeks gestation) face high mortality and morbidity.
  • Previous care strategies had limited success in improving outcomes for this population.

Purpose of the Study:

  • To evaluate the impact of implementing proactive perinatal care with minimal handling on periviable preterm infants.
  • To compare outcomes before and after the introduction of this new care protocol.

Main Methods:

  • Retrospective cohort study over 10 years (2013-2022), divided into Phase I (pre-implementation) and Phase II (post-implementation).
  • Included 162 infants born between 22 0/7 and 25 6/7 weeks of gestation.
  • Analyzed mortality and composite outcomes (severe brain injury, sepsis, necrotizing enterocolitis) in relation to care phase and other factors.

Main Results:

  • Mortality decreased significantly from 54.4% in Phase I to 24.3% in Phase II (P=0.001).
  • Composite outcomes of severe brain injury or death, sepsis or death, and necrotizing enterocolitis or death showed improvement with proactive care.
  • Independent factors associated with mortality included gestational age, air leak syndrome, massive pulmonary hemorrhage, and birth in Phase I.

Conclusions:

  • Implementation of proactive perinatal care with minimal handling led to increased survival rates.
  • This approach significantly reduced combined morbidities, improving overall clinical outcomes for periviable preterm infants.
  • Proactive perinatal care with minimal handling is essential for optimizing survival and clinical results in this high-risk group.
Abstract

Keywords:
Minimal handlingMortalityPeriviable preterm infantProactive perinatal care

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