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Survival assessment in extremely preterm neonates in a middle-income setting
Maria J Rodriguez-Sibaja1, Olivo Herrera-Ortega1, Mario I Lumbreras-Marquez1,2
1Maternal-Fetal Medicine Division, Instituto Nacional de Perinatologia, Mexico City, Mexico.
Insights
Extremely preterm infants born in middle-income settings show improved survival rates from 26 weeks gestation. However, survival varies by calculation method, and most survivors experience significant neonatal morbidity.
Area of Science:
- Neonatology
- Perinatal Medicine
- Public Health
Background:
- Globally, 15.1 million preterm neonates are born annually, with 1% being extremely preterm (<28.0 weeks gestation).
- Survival and outcomes for extremely preterm infants are influenced by gestational age, birth weight, and medical resources.
- Middle-income settings present unique challenges for neonatal care and survival.
Purpose of the Study:
- To describe hospital discharge survival rates of extremely preterm infants in a middle-income country.
- To assess the neonatal morbidity associated with extremely preterm birth.
Main Methods:
- A cross-sectional study analyzing singleton pregnancies.
- Neonatal survival was calculated using three denominators: total extremely preterm births, all live births, and NICU admissions.
- Neonatal morbidity was assessed as a secondary outcome.
Main Results:
- No infants born before 24.6 weeks gestation survived to discharge.
- Mortality decreased with increasing gestational age, with survival rates to NICU discharge reaching 69% at 27 weeks.
- Survival rates varied significantly based on the denominator used.
- 97.0% of NICU survivors were diagnosed with major morbidity.
Conclusions:
- Survival rates for extremely preterm infants exceed 50% from 26 weeks gestation in a middle-income setting.
- The choice of denominator critically impacts reported neonatal survival rates.
- Survival after extremely preterm birth is associated with substantial neonatal morbidity.
Introduction:
Globally, an estimated 15.1 million preterm neonates are born annually, with 1% classified as extremely preterm (i.e., <28.0 weeks of gestation). The survival and outcomes of this vulnerable population are influenced by multiple factors, particularly gestational age, birth weight, and available medical resources. This study aimed to describe the hospital discharge survival of extremely preterm infants born in a middle-income setting. As a secondary objective, we assessed the neonatal morbidity associated with this group.
Material And Methods:
In this cross-sectional study of singleton pregnancies, neonatal survival following extremely preterm birth was determined using three different denominators and expressed as prevalence (i.e., percentages): (1) the total number of extremely preterm births, including intrapartum fetal deaths; (2) the total number of all live births, including neonatal deaths in the delivery room, and (3) the total number of preterm neonates admitted to the neonatal intensive care unit (NICU). Neonatal morbidity was assessed as a secondary outcome.
Results:
There were no live births between 22.0 and 23.6 weeks of gestation. Overall mortality decreased with increasing gestational age, from 100% (22/22) at <24.0 weeks of gestation to 87% (14/16), 42% (16/38), and 21% (11/52) at a gestational age of 25, 26, and 27 weeks, respectively. The survival rate to NICU discharge among extremely preterm infants was 49% (65/132), 67% (65/97), and 69% (65/93), depending on whether survival was calculated based on all births, all live births, or NICU admissions, respectively. None of the neonates born before 24.6 weeks of gestation survived to discharge. Notably, 97.0% of NICU survivors were diagnosed with major morbidity.
Conclusion:
The survival rate at NICU discharge exceeds 50% from 26 weeks onwards in a middle-income setting. Importantly, survival rates varied significantly depending on the denominator used, highlighting the need to carefully select inclusion criteria in neonatal survival analyses. Notably, survival after extremely preterm birth was associated with significant morbidity.
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