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Changes over time in attitudes to treatment and survival rates for extremely preterm infants (23-27 weeks'
Insights
Treatment of very preterm infants has improved significantly, with increased intensive care and higher survival rates over time. Survival rates are strongly linked to gestational age, showing marked improvements in the 1990s.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Pediatric Intensive Care
Background:
- Very preterm infants (23-27 weeks gestational age) have historically faced high mortality rates.
- Advances in neonatal care aim to improve outcomes for extremely premature infants.
Purpose of the Study:
- To analyze trends in intensive treatment and survival rates for very preterm infants.
- To assess the impact of gestational age on treatment and survival outcomes.
- To evaluate changes in care and outcomes over a 12-year period.
Main Methods:
- Retrospective analysis of consecutive livebirths between 23-27 weeks gestational age (1983-1994).
- Data collection on intensive treatment proportions and survival to hospital discharge.
- Exclusion of infants with lethal abnormalities.
Main Results:
- Overall survival rate increased from 43% (1983-1985) to 70% (1992-1994).
- Proportion of infants receiving intensive treatment rose from 74% to 91% over the study period.
- Survival rates significantly correlated with gestational age, increasing from 3% at 23 weeks to 78% at 27 weeks.
Conclusions:
- Intensive treatment and survival rates for very preterm infants have significantly increased over time.
- Higher gestational age is consistently associated with better survival outcomes.
- Significant improvements in survival, particularly at 24-25 weeks gestational age, occurred in the 1990s.
Abstract:
We determined the changes over time in attitude to treatment of very preterm infants (23-27 weeks of gestational age) born at the Royal Women's Hospital, Melbourne, and their survival rate. The subjects were consecutive livebirths at 23-27 weeks' gestational age born from 1983-1994, inclusive. The main outcomes measured were the proportions of livebirths treated intensively and survival rates to hospital discharge, both excluding lethal abnormalities. Over the 12 years of the study there were 788 livebirths free of lethal abnormalities born at 23-27 week's gestational age. Overall 669 (85%) were treated intensively; the proportions treated intensively rose significantly over time from 74% in 1983-1985 to 91% in 1992-1994, and with increasing gestational age, from 19% at 23 weeks to 100% at 27 weeks. Overall 439 (56%) survived their primary hospitalization; the survival rate rose significantly over time, from 43% in 1983-1985 to 70% in 1992-1994, and with increasing gestational age, from 3% at 23 weeks to 78% at 27 weeks. In 1992-1994, the survival rates were 11% at 23 weeks, 53% at 24 weeks, 70% at 25 weeks, 81% at 26 weeks, and 87% at 27 weeks. For infants treated intensively, the survival rate rose significantly from 53% in 1983-1985 to 76% in 1992-1994. The largest increases in survival have occurred in the 1990s, and at 24 and 25 weeks' gestational age. The proportions of very preterm infants treated intensively and their survival rates have increased over time, and have always been higher with increasing gestational age.
