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Need for national guidance regarding proactive care of infants born at 22-23 weeks' gestation
1Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea.
Insights
Improving survival for extremely preterm infants (22-23 weeks gestation) hinges on proactive, high-quality neonatal intensive care. National guidance and centralized care models significantly enhance outcomes for these vulnerable newborns.
Area of Science:
- Neonatology
- Perinatology
- Developmental Pediatrics
Background:
- The limit of viability for preterm infants has advanced to 22-23 weeks' gestation.
- Infants born at this early gestational age face high risks of mortality and severe neurodevelopmental impairments.
- Care decisions for these infants are complex, influenced by ethical, legal, and resource availability factors.
Purpose of the Study:
- To examine the impact of proactive care and national guidance on the survival rates of extremely preterm infants (22-23 weeks' gestation).
- To highlight the importance of neonatal intensive care unit (NICU) resources and care models in determining outcomes.
- To propose strategies for improving survival in regions with limited specialist resources.
Main Methods:
- Comparative analysis of care practices and survival rates across different countries (Japan, Sweden, Korea).
- Review of national guidelines and the implementation of proactive neonatal care.
- Assessment of the role of centralized care models and maternal transfer in resource-limited settings.
Main Results:
- Countries with established national guidance and proactive care, like Japan and Sweden, show higher survival rates for 22-23 week infants.
- Variations in proactive care provision and survival exist globally due to differing guidelines and resources.
- Centralized care and maternal transfer are identified as crucial for improving survival in regions with neonatologist shortages.
Conclusions:
- The survival of extremely preterm infants is critically dependent on the quality of proactive neonatal intensive care.
- Implementing national guidance, enhancing NICU practices, and centralizing care can significantly improve survival rates.
- Maternal transfer to specialized centers is vital in resource-limited areas to ensure adequate care for these vulnerable infants.
Abstract:
With recent rapid improvements in neonatal intensive care, the limit of viability has shifted downward to 22-23 weeks' gestation. The younger the gestational age of preterm infants, the higher the risk of survival despite severe neurodevelopmental impairments. For infants born at 22-23 weeks' gestation, the limit of viability, neurodevelopmental outcomes, and survival rates may be determined by the quality of proactive care. Owing to the high risk of severe neurodevelopmental impairment in 22-23 weeks' gestation, proactive care is sometimes withheld according to ethical or legal considerations, and there are significant differences in the provision of proactive care and survival rates across countries or institutions. Additionally, there are differing or even lacking guidelines regarding the care of these infants across countries and institutions. Japan and Sweden are countries with well-established national guidance and proactive care for infants born at 22-23 weeks' gestation, resulting in higher survival rates among them. In Korea, where there is an extreme shortage of neonatologists, maternal transfer before delivery at 22-23 weeks' gestation to high-activity regions with appropriate neonatal intensive care unit resources, such as adequate personnel and facilities similar to the centralized care model seen in Sweden, is crucial for improving the survival rates of infants born at 22-23 weeks' gestation. The survival of these infants largely depends on the quality of proactive care provided. This rate is not static and can be improved through proactive care based on national guidance and the implementation of enhanced neonatal intensive care practices, including centralization of care.
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